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[ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":313032.37,"maximum":574258.09,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":574258.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":435590.52},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":371671.73},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":323817.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":313032.37},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":369786.22},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":319032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":446645.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":415868.09},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":319032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":334983.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":542354.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":435929.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":324455.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":319032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":319032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":435628.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":319032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":317277.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":319032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":319032.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":24154.6,"maximum":43718.72,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43718.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35327.58},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":30143.59},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24652.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25387.78},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29990.67},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24288.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34003.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33728.04},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24288.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25502.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41289.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35355.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24701.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24288.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24288.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35330.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24288.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24154.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":24288.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24288.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":29724.68,"maximum":53800.33,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53800.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44916.06},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":38325.06},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30337.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":32278.44},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38130.63},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29889.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41844.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42882.38},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29889.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31383.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50811.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44951.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30397.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29889.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29889.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44919.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":29889.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29724.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":29889.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29889.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14049.45,"maximum":25428.87,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25428.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20300.88},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17321.92},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14339.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14589.01},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17234.05},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19778.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19381.71},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14127.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24016.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20316.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14367.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20302.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14127.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14049.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14127.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10156.27,"maximum":18984.08,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18984.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14132.65},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12058.82},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10704.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10156.27},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11997.64},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14765.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13492.76},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11074.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17929.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14143.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10726.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14133.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10488.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":11426.26,"10th_percentile":11426.26,"90th_percentile":11426.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":17022.75,"10th_percentile":17022.75,"90th_percentile":17022.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12084.6,"maximum":21999.94,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21999.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16815.95},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14348.36},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12405.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12084.6},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14275.57},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12222.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17111.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16054.56},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12222.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12833.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20777.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16829.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12429.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12222.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12222.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16817.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12222.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12222.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12222.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14297.64,"maximum":27941.65,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27941.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19895.44},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16975.97},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15755.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14297.64},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16889.85},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21732.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18994.63},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16299.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26389.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19910.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15787.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19897.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15437.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15523.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11540.88,"maximum":21034.82,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21034.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16059.36},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13702.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11861.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11540.88},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13633.28},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16360.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15332.23},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11686.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12270.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19866.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16071.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11884.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16060.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11686.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11621.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11686.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":11332.79,"10th_percentile":11332.79,"90th_percentile":11332.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14257.92,"maximum":25806.19,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25806.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21055.16},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17965.52},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14551.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15131.06},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17874.38},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14336.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20071.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20101.84},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14336.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15053.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24372.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21071.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14580.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14336.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14336.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21056.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14336.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14257.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14336.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14336.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":20285.87,"10th_percentile":20285.87,"90th_percentile":20285.87,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13965.64,"10th_percentile":13965.64,"90th_percentile":13965.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21481.54,"10th_percentile":21481.54,"90th_percentile":21481.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11377.43,"maximum":20592.63,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20592.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16092.85},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13731.38},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11611.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11564.95},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13661.72},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16016.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15364.21},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11440.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12012.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16105.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11634.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16094.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11440.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11377.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11440.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13850.22,"maximum":26493.3,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26493.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19272.84},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16444.74},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14939.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13850.22},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16361.31},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14718.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20605.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18400.22},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14718.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15454.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25021.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19287.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14968.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14718.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14718.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19274.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14718.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14637.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14718.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14718.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8120.04,"maximum":15997.32,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15997.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11299.19},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9641.14},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9020.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8120.04},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9592.23},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8887.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12442.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10787.59},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8887.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9331.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15108.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11307.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9038.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8887.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8887.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11300.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8887.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8838.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8887.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8887.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14087.49,"maximum":25497.72,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25497.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20290.49},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17313.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14377.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14581.54},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17225.22},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19831.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19371.78},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14165.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14873.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24081.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20306.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14406.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20292.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14165.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14087.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14165.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9419.14,"maximum":18206.93,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18206.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13106.92},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11183.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10266.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9419.14},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11126.87},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14160.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12513.47},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10114.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10620.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17195.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13117.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10286.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13108.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10114.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10059.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10114.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":34194.64,"maximum":61890.75,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61890.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53237.4},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":45425.32},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34899.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":38258.48},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45194.87},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48137.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50826.95},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34383.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36102.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58452.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53278.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34968.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53242.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":34383.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34194.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":34383.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31984.16,"10th_percentile":31984.16,"90th_percentile":31984.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6761.16,"maximum":13213.13,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13213.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9408.29},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8027.71},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7450.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6761.16},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7986.99},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10276.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8982.31},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7340.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7707.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12479.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9415.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9409.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7340.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7300.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7340.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8825.92,"10th_percentile":8825.92,"90th_percentile":8825.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":15951.02,"10th_percentile":15951.02,"90th_percentile":15951.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6850.22,"10th_percentile":6850.22,"90th_percentile":6850.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8865.47,"maximum":16643.39,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16643.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12336.47},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10526.21},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9385.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8865.47},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10472.81},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9246.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12944.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11777.9},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9246.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9708.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15718.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12346.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9403.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9246.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9246.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12337.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9246.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9195.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9246.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9246.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7081.9,"10th_percentile":7081.9,"90th_percentile":8649.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5372.41,"maximum":11055.15,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11055.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7475.81},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6378.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6233.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5372.41},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6346.44},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6141.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8598.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7137.32},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6141.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6448.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10440.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7481.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6246.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6141.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6141.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7476.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6141.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6107.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6141.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6141.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5639.35,"10th_percentile":5639.35,"90th_percentile":5639.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9192.53,"maximum":17109.41,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17109.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12791.58},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10914.53},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9647.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9192.53},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10859.16},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13307.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12212.41},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9505.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9980.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16158.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12801.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9666.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12792.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9505.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9452.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9505.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":12614.97,"10th_percentile":12510.88,"90th_percentile":12962.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9125.29,"10th_percentile":9125.29,"90th_percentile":9125.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":9441.12,"10th_percentile":9441.12,"90th_percentile":9441.12,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10721.63,"10th_percentile":10721.63,"90th_percentile":10721.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7360.39,"10th_percentile":7360.39,"90th_percentile":9406.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","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":8384.36,"10th_percentile":8384.36,"90th_percentile":8384.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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":206396.06,"maximum":373567.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":373567.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":325350.09},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":277608.04},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":210650.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":233809.29},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":276199.72},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207537.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":290552.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":310619.06},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":207537.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217914.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":352813.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":325603.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211065.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207537.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207537.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":325378.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":207537.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":206396.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":207537.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207537.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":53899.48,"maximum":97555.63,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97555.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":92091.5},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":78577.95},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55010.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":66180.55},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78179.32},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54197.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75876.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87921.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54197.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56907.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92135.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92163.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55118.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54197.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54197.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92099.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":54197.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53899.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":54197.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54197.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":53598.85,"maximum":97011.49,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97011.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":91561.31},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":78125.56},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54703.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":65799.54},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77729.22},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53895.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75453.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87415.65},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53895.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56590.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91621.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91632.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54811.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53895.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53895.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91569.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":53895.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53598.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":53895.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53895.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":19866.03,"maximum":35956.62,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35956.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28503.25},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":24320.67},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20275.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20483.55},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24197.29},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19975.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27966.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27212.69},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19975.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20974.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33959.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28525.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20315.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19975.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19975.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28505.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19975.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19866.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19975.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19975.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18881.45,"maximum":34203.76,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34203.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26273.9},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22418.46},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19287.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18881.45},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22304.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19002.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26602.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25084.29},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19002.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19952.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32303.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26294.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19325.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19002.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19002.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26276.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19002.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18897.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19002.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19002.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14660.96,"maximum":26535.67,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26535.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23245.23},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19834.21},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14963.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16704.93},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19733.59},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14742.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20638.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22192.75},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14742.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15479.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25061.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23263.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14992.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14742.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14742.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23247.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14742.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14660.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14742.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14742.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7407.81,"maximum":14732.98,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14732.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10308.11},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8795.49},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8307.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7407.81},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8750.87},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8184.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11458.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9841.39},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8184.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8594.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13914.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10316.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8324.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8184.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8184.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10309.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8184.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8139.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8184.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8184.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8298.13,"10th_percentile":8298.13,"90th_percentile":8298.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7318.16,"maximum":13999.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13999.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10183.36},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8689.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7894.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7318.16},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8644.97},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7777.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10888.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9722.28},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7777.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8166.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13221.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10191.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7909.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7777.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7777.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10184.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7777.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7734.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7777.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7777.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7448.01,"maximum":13480.56,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13480.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10591.11},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9036.97},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7601.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7611.19},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8991.12},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7489.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10484.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10111.57},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7489.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7863.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12731.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10599.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7616.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7489.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7489.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10592.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7489.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7448.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7489.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7489.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7935.76,"maximum":15209.59,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15209.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11042.76},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9422.34},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8576.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7935.76},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9374.54},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11829.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10542.77},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14364.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11051.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11043.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8789.1,"maximum":16099.27,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16099.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12230.2},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10435.53},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9078.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8789.1},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10382.59},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8944.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12521.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11676.45},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8944.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15204.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12239.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9096.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8944.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8944.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12231.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8944.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8894.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8944.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8944.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":12014.4,"10th_percentile":11853.07,"90th_percentile":12191.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8593.56,"10th_percentile":8593.56,"90th_percentile":8593.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2454.37,"10th_percentile":2454.37,"90th_percentile":2454.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8612.54,"10th_percentile":8612.54,"90th_percentile":8612.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15578.94,"maximum":28197.18,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28197.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22931.05},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19566.13},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15900.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16479.15},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19466.87},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15665.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21931.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21892.79},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15665.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16448.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26630.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22948.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15931.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15665.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15665.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22933.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15665.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15578.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15665.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15665.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7648.78,"10th_percentile":7648.78,"90th_percentile":7648.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8953.46,"maximum":16918.76,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16918.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12458.91},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10630.68},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9540.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8953.46},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10576.75},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9399.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13159.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11894.8},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9399.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9869.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15978.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12468.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9559.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9399.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9399.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12459.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9399.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9399.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9399.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":21517.68,"maximum":38946.02,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38946.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31004.04},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":26454.49},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21961.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22280.71},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26320.28},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21636.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30291.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29600.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21636.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22718.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36782.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31028.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22004.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21636.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21636.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31006.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21636.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21517.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":21636.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21636.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":31750.23,"10th_percentile":31750.23,"90th_percentile":31750.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":16714.79,"10th_percentile":16714.79,"90th_percentile":16714.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":34557.98,"10th_percentile":34557.98,"90th_percentile":34557.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20079.8,"10th_percentile":18549.12,"90th_percentile":21416.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":38120.68,"maximum":69283.48,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69283.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53045.66},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":45261.71},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39068.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":38120.68},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45032.09},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38490.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53887.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50643.88},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38490.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40415.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65434.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53086.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39145.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38490.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38490.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53050.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":38490.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38279.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":38490.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38490.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":32051.45,"maximum":58011.68,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58011.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47495.4},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":40525.9},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32712.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":34132.05},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40320.31},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32228.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45120.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45344.93},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32228.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33840.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54788.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47532.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32776.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32228.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32228.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47499.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32228.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32051.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":32228.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32228.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17376.14,"maximum":31450.03,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31450.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26714.0},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22793.97},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17734.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19197.72},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22678.34},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17472.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24461.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25504.46},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17472.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18345.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29702.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26734.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17769.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17472.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17472.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26716.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17472.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17376.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17472.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17472.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":346.6,"10th_percentile":346.6,"90th_percentile":346.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":23287.63,"maximum":44154.29,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44154.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32405.18},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":27650.02},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24898.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":23287.63},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27509.75},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34342.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30937.95},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24530.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25756.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41701.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32430.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24947.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32407.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24530.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24395.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":24530.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":46238.88,"maximum":83690.28,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83690.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":69195.11},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":59041.38},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47192.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":49726.31},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58741.86},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46494.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65092.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66062.13},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46494.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48819.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79040.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69249.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47285.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46494.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46494.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69201.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":46494.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46238.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":46494.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46494.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":25489.51,"maximum":46134.86,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46134.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36048.36},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":30758.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26014.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25905.76},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30602.56},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25630.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35882.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34416.18},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25630.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26912.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43571.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36076.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26066.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25630.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25630.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36051.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25630.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25489.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":25630.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25630.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6019.06,"maximum":12128.85,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12128.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8375.63},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7146.59},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6839.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6019.06},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7110.33},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6738.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9433.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7996.4},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6738.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7075.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11455.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8382.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6852.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6738.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6738.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8376.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6738.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6701.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6738.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6738.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7678.05,"10th_percentile":7678.05,"90th_percentile":8265.25,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5378.13,"10th_percentile":5378.13,"90th_percentile":5378.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":4466.0,"10th_percentile":4466.0,"90th_percentile":4466.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6188.01,"10th_percentile":6188.01,"90th_percentile":6674.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8126.68,"maximum":14864.06,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14864.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11308.43},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9649.02},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8381.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8126.68},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9600.07},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8257.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11560.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10796.41},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8257.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8670.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14038.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11317.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8398.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8257.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8257.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11309.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8257.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8212.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8257.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8257.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":3665.72,"maximum":8580.76,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8580.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":5100.92},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":4352.41},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4838.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3665.72},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4330.33},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4767.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6673.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4869.96},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4767.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5005.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8104.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5104.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4848.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4767.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4767.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5101.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":4767.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4740.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":4767.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4767.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12429.92,"maximum":23417.86,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23417.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17296.47},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14758.37},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13205.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12429.92},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14683.5},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13009.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18213.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16513.33},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13009.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13660.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22116.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17309.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13231.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13009.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13009.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17297.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13009.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13009.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13009.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":16214.0,"10th_percentile":16214.0,"90th_percentile":16214.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":265.53,"10th_percentile":265.53,"90th_percentile":265.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16664.43,"maximum":30161.86,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30161.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24873.92},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21223.91},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17007.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17875.37},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21116.24},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16756.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23459.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23747.7},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16756.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28486.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24893.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17041.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16756.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16756.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24876.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16756.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16664.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16756.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16756.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":24875.08,"10th_percentile":24875.08,"90th_percentile":24875.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":23181.97,"10th_percentile":23181.97,"90th_percentile":23181.97,"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":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":24877.23,"10th_percentile":24877.23,"90th_percentile":24877.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15214.16,"10th_percentile":14590.98,"90th_percentile":16168.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":33065.27,"maximum":59846.63,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59846.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49198.02},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":41978.68},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33746.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":35355.62},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41765.72},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33248.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46547.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46970.46},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33248.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34910.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56521.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49236.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33813.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33248.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33248.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49202.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":33248.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33065.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":33248.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33248.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32905.32,"10th_percentile":32905.32,"90th_percentile":32905.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13704.95,"maximum":24835.77,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24835.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19070.7},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16272.26},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14004.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13704.95},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16189.71},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19316.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18207.23},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13797.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14487.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23456.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19085.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19072.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13797.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13721.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13797.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":19112.09,"10th_percentile":19112.09,"90th_percentile":33006.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":13553.3,"10th_percentile":13553.3,"90th_percentile":13553.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":19072.35,"10th_percentile":19072.35,"90th_percentile":19072.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12777.92,"10th_percentile":12777.92,"90th_percentile":13549.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12361.85,"maximum":22476.55,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22476.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17201.75},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14677.56},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12674.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12361.85},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14603.1},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17481.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16422.9},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12486.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13111.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21227.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17215.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12699.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17203.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12486.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12418.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12486.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":17291.99,"10th_percentile":17291.99,"90th_percentile":17291.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":12062.05,"10th_percentile":12062.05,"90th_percentile":12062.05,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":22639.01,"maximum":40975.58,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40975.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33876.77},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":28905.68},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23105.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24345.17},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28759.04},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22764.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31869.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32342.92},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22764.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23902.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38699.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33903.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23151.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22764.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22764.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33879.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22764.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22639.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":22764.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22764.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5793.27,"maximum":11833.61,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11833.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8061.44},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6878.5},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6672.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5793.27},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6843.61},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6574.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9203.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7696.44},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6574.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6902.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11176.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8067.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6685.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6574.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6574.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8062.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6574.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6538.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6574.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6574.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8183.96,"maximum":15539.26,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15539.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11388.13},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9717.03},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8762.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8183.96},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9667.74},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8632.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12086.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10872.51},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8632.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9064.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14675.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11397.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8632.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8632.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11389.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8632.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8585.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8632.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8632.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9275.34,"10th_percentile":9275.34,"90th_percentile":9275.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":3246.29,"10th_percentile":3246.29,"90th_percentile":3246.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":1166.55,"10th_percentile":1166.55,"90th_percentile":1166.55,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":8102.38,"10th_percentile":257.73,"90th_percentile":8549.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8237.91,"maximum":15480.99,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15480.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11463.21},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9781.09},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8729.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8237.91},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9731.47},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8600.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12040.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10944.19},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8600.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9030.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14620.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11472.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8746.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8600.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8600.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11464.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8600.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8553.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8600.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8600.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":11465.36,"10th_percentile":11465.36,"90th_percentile":11465.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":16792.86,"10th_percentile":16792.86,"90th_percentile":16792.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8154.69,"10th_percentile":8154.69,"90th_percentile":8154.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7813.73,"maximum":14943.49,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14943.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10872.96},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9277.45},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8426.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7813.73},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9230.39},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8301.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11622.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10380.66},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8301.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14113.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10881.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8443.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8301.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8301.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10873.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8301.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8256.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8301.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8301.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10872.96,"10th_percentile":10872.96,"90th_percentile":10872.96,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6727.59,"10th_percentile":6727.59,"90th_percentile":6727.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":8239.52,"10th_percentile":8239.52,"90th_percentile":8239.52,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6745.0,"10th_percentile":6169.19,"90th_percentile":7777.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17647.51,"maximum":31941.2,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31941.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24668.32},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21048.47},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18011.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17727.62},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20941.69},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24843.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23551.4},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18632.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30166.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24687.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24670.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17647.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17745.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16419.38,"maximum":29916.94,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29916.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22847.88},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19495.17},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16869.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16419.38},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19396.27},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23268.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21813.38},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16620.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17451.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28254.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22865.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16903.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22849.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16620.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16529.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16620.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":22849.03,"10th_percentile":22849.03,"90th_percentile":22849.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":31789.59,"maximum":57537.72,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57537.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46979.07},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":40085.34},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32444.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":33761.0},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39881.98},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31965.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44751.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44851.98},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31965.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33563.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54341.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47015.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32508.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31965.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31965.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46983.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":31965.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31789.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":31965.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31965.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":22248.86,"10th_percentile":22248.86,"90th_percentile":22248.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":377.5,"10th_percentile":377.5,"90th_percentile":377.5,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15808.62,"maximum":28612.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28612.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22629.56},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19308.89},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16134.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16262.49},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19210.93},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15896.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22254.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21604.95},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15896.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16690.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27023.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22647.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16166.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15896.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15896.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22631.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15896.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15808.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15896.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15896.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":17273.84,"10th_percentile":17273.84,"90th_percentile":18168.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":39371.73,"10th_percentile":39371.73,"90th_percentile":39371.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":42341.6,"10th_percentile":42341.6,"90th_percentile":42341.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14883.69,"10th_percentile":13266.98,"90th_percentile":14923.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5105.95,"maximum":10782.43,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10782.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7105.02},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6062.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6080.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5105.95},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6031.67},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5990.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8386.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6783.32},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5990.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6289.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10183.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7110.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6092.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5990.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5990.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7105.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5990.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5957.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":5990.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5990.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7000.02,"10th_percentile":6861.59,"90th_percentile":7105.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":4871.74,"10th_percentile":4871.74,"90th_percentile":4871.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5440.81,"10th_percentile":5440.81,"90th_percentile":5440.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":32431.82,"maximum":58700.12,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58700.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47165.04},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":40244.02},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33100.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":33894.64},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40039.86},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32611.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45655.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45029.53},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32611.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34241.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55439.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47201.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33165.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32611.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32611.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47169.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32611.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":32611.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32611.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":62253.3,"10th_percentile":62253.3,"90th_percentile":62253.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":54968.68,"10th_percentile":54968.68,"90th_percentile":54968.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30590.87,"10th_percentile":30590.87,"90th_percentile":30590.87,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":43101.65,"maximum":78012.04,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78012.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":62383.49},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":53229.3},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43990.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":44831.21},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52959.26},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43340.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60676.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59558.92},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43340.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45507.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73678.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62432.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44076.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43340.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43340.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62388.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":43340.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43101.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":43340.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43340.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":36732.08,"maximum":66483.4,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66483.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":56103.21},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":47870.59},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37489.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":40317.96},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47627.74},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36935.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51709.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53563.0},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36935.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38781.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62789.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56146.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37563.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36935.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36935.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56108.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":36935.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36732.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":36935.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36935.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2414.25,"10th_percentile":2414.25,"90th_percentile":2414.25,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34604.65,"10th_percentile":34604.65,"90th_percentile":34604.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14740.09,"maximum":27165.85,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27165.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20511.11},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17501.3},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15318.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14740.09},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17412.51},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15092.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21129.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19582.42},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15092.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15846.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25656.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20527.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15348.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15092.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15092.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20512.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15092.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15009.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15092.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15092.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14350.81,"maximum":25974.32,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25974.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22701.18},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19370.0},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14646.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16313.96},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19271.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14430.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20202.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21673.33},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14430.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24531.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22718.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14675.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14430.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14430.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22703.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14430.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14350.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14430.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14430.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9896.13,"10th_percentile":9896.13,"90th_percentile":9896.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":20957.53,"maximum":42495.43,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42495.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29162.81},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":24883.44},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23962.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20957.53},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24757.21},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23608.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33052.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27842.39},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23608.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24789.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40134.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29185.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24009.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23608.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23608.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29165.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23608.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23478.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":23608.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23608.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21338.64,"10th_percentile":21338.64,"90th_percentile":21338.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11280.87,"maximum":20417.87,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20417.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17314.95},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14774.14},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11513.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12443.2},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14699.19},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11343.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15880.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16530.97},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11343.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11910.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19283.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17328.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11536.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11343.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11343.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17316.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11343.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11343.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11343.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8463.7,"maximum":16090.0,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16090.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11777.4},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10049.18},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9072.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8463.7},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9998.2},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8938.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12514.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11244.15},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8938.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9385.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15196.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11786.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9090.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8938.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8938.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11778.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8938.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8889.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8938.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8938.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8569.9,"10th_percentile":8569.9,"90th_percentile":8569.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16902.15,"maximum":30592.13,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30592.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24351.82},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":20778.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17250.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17500.17},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20673.01},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16995.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23793.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23249.23},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16995.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17845.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28892.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24370.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16995.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16995.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24353.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16995.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16902.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16995.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16995.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":15137.39,"10th_percentile":15137.39,"90th_percentile":15137.39,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15851.34,"10th_percentile":14924.95,"90th_percentile":16676.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15938.93,"10th_percentile":15938.93,"90th_percentile":15938.93,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10744.81,"maximum":19717.52,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19717.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14951.61},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12757.61},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11118.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10744.81},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12692.89},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10954.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15335.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14274.64},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10954.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11501.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18622.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14963.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11140.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10954.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10954.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14952.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10954.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10893.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10954.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10954.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15535.78,"maximum":28119.06,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28119.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23269.49},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19854.91},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15856.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16722.36},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19754.19},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15621.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21870.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22215.91},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15621.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16402.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26556.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23287.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15887.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15621.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15621.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23271.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15621.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15535.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15621.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15621.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6777.77,"maximum":13552.06,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13552.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9431.39},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8047.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7641.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6777.77},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8006.6},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7528.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10540.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9004.36},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7528.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12799.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9438.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7656.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7528.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7528.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9432.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7528.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7528.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7528.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9013.54,"10th_percentile":9013.54,"90th_percentile":9013.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7140.16,"10th_percentile":7140.16,"90th_percentile":7140.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":7473.0,"10th_percentile":7473.0,"90th_percentile":7473.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":10020.09,"10th_percentile":10020.09,"90th_percentile":10020.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":267.53,"10th_percentile":265.52,"90th_percentile":6864.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12702.83,"maximum":22991.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22991.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18125.83},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15466.04},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12964.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13025.93},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15387.58},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17882.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17305.14},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13411.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21714.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18139.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12990.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18127.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12702.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12773.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12216.19,"10th_percentile":12216.19,"90th_percentile":12216.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":20940.84,"10th_percentile":20940.84,"90th_percentile":20940.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":12110.02,"10th_percentile":12110.02,"90th_percentile":12110.02,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10685.79,"10th_percentile":10685.79,"90th_percentile":10685.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14556.36,"maximum":26346.35,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26346.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23061.57},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19677.5},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14856.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16572.95},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19577.68},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14636.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20491.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22017.4},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14636.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15368.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24882.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23079.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14636.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14636.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23063.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14636.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14636.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14636.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13634.39,"maximum":25385.18,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25385.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18972.52},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16188.48},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14314.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13634.39},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16106.36},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14102.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19744.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18113.49},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14102.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14808.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23974.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18987.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14342.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14102.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14102.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18974.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14102.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14025.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14102.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14102.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13606.19,"maximum":24626.59,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24626.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20289.33},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17312.06},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13886.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14580.71},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17224.24},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13681.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19154.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19370.68},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13681.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14365.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23258.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20305.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13914.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13681.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13681.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20291.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13681.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13606.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13681.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13681.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7667.63,"maximum":14682.67,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14682.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10669.66},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9103.99},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8279.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7667.63},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9057.8},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8157.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11419.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.56},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8157.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13866.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10677.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8157.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8157.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10670.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8157.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8157.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8157.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":7228.54,"10th_percentile":7228.54,"90th_percentile":7228.54,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":1107.0,"10th_percentile":1107.0,"90th_percentile":1107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7569.25,"10th_percentile":7284.79,"90th_percentile":7617.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":22532.22,"maximum":40782.29,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40782.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31492.65},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":26871.4},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22996.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22631.85},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26735.08},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22656.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31719.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30066.74},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22656.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23789.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38516.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31517.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23042.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22656.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22656.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31495.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22656.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22532.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":22656.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22656.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10515.71,"maximum":20141.17,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20141.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14632.81},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12485.58},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11357.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10515.71},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12422.24},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11189.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15665.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13970.27},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11189.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11749.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19022.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14644.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11379.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11189.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11189.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14634.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11189.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11128.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11189.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11189.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6487.23,"maximum":12858.32,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12858.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9027.11},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7702.46},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7250.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6487.23},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7663.39},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10000.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8618.38},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7143.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7500.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12143.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9034.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7264.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9027.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7143.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7104.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7143.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8467.25,"10th_percentile":7008.73,"90th_percentile":10135.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6544.9,"10th_percentile":6544.9,"90th_percentile":6544.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":4769.23,"10th_percentile":4769.23,"90th_percentile":4769.23,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6663.41,"10th_percentile":6663.41,"90th_percentile":6663.41,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":8427.08,"10th_percentile":8427.08,"90th_percentile":8427.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":21509.64,"10th_percentile":21509.64,"90th_percentile":21509.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6616.25,"10th_percentile":252.53,"90th_percentile":6636.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6669.91,"10th_percentile":6669.91,"90th_percentile":6669.91,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":39421.66,"maximum":71351.42,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71351.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64387.58},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":54939.32},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40234.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":46271.43},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54660.61},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39639.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55495.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61472.28},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39639.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41621.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67387.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64437.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40313.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39639.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39639.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64393.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":39639.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39421.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":39639.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39639.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8521.81,"maximum":16263.43,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16263.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11858.26},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10118.17},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9170.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8521.81},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10066.84},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9035.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12649.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11321.34},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9035.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9487.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15359.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11867.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9188.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9035.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9035.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11859.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9035.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8985.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9035.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9035.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":12104.28,"10th_percentile":12104.28,"90th_percentile":12248.66,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9545.43,"10th_percentile":9545.43,"90th_percentile":9545.43,"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":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":8917.42,"10th_percentile":8917.42,"90th_percentile":8917.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8369.37,"10th_percentile":8369.37,"90th_percentile":8369.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12764.28,"maximum":23102.77,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23102.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17875.17},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15252.16},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13027.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12845.8},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15174.79},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12834.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17968.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17065.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12834.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13476.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21819.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17889.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13053.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12834.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12834.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17876.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12834.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12764.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12834.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12834.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12052.31,"10th_percentile":12052.31,"90th_percentile":12052.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7378.76,"maximum":14150.47,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14150.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10267.68},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8761.0},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7979.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7378.76},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8716.55},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7861.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11005.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9802.79},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7861.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8254.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13364.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10275.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7995.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7861.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7861.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10268.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7861.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7818.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7861.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7861.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":5161.08,"10th_percentile":5161.08,"90th_percentile":5161.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9547.79,"10th_percentile":8622.51,"90th_percentile":10395.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":7245.94,"10th_percentile":6238.14,"90th_percentile":7394.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":20128.58,"10th_percentile":20128.58,"90th_percentile":20128.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":7256.76,"10th_percentile":7256.76,"90th_percentile":7256.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":9802.79,"10th_percentile":9802.79,"90th_percentile":9802.79,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":7338.31,"10th_percentile":7338.31,"90th_percentile":7393.9,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7269.93,"10th_percentile":7269.93,"90th_percentile":7269.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":8787.77,"10th_percentile":8787.77,"90th_percentile":8787.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":11027.61,"10th_percentile":11027.61,"90th_percentile":11027.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":6552.37,"10th_percentile":5815.28,"90th_percentile":7421.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","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":4967.83,"10th_percentile":4967.83,"90th_percentile":4967.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6486.4,"maximum":12904.67,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12904.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9025.95},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7701.48},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7276.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6486.4},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7662.41},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7169.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10036.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8617.28},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7169.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7527.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12187.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9032.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7291.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7169.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7169.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9026.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7169.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7169.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7169.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":2499.0,"10th_percentile":2499.0,"90th_percentile":2499.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8845.43,"10th_percentile":8845.43,"90th_percentile":8845.43,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7349.43,"10th_percentile":7349.43,"90th_percentile":7349.43,"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":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":11178.2,"10th_percentile":11178.2,"90th_percentile":11178.2},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":9287.02,"10th_percentile":9287.02,"90th_percentile":9287.02,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":9026.73,"10th_percentile":9026.73,"90th_percentile":9026.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4025.49,"10th_percentile":4025.49,"90th_percentile":4025.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":488.29,"10th_percentile":488.29,"90th_percentile":488.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12305.4,"maximum":22867.11,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22867.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17123.2},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14610.53},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12894.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12305.4},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14536.41},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12703.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17785.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16347.91},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12703.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13339.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21596.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17136.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12919.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12703.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12703.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17124.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12703.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12634.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12703.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12703.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16313.95,"10th_percentile":16313.95,"90th_percentile":16313.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":16525.84,"10th_percentile":16525.84,"90th_percentile":16525.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11588.78,"10th_percentile":11588.78,"90th_percentile":11588.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11780.78,"maximum":22030.4,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22030.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16393.18},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13987.64},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12422.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11780.78},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13916.68},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12239.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17134.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15650.94},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12239.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12851.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20806.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16405.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12447.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12239.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12239.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16394.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12239.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12171.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12239.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12239.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12196.66,"maximum":22187.93,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22187.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16971.88},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14481.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12511.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12196.66},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14407.96},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12326.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16203.44},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12326.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12942.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20955.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16985.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12536.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12326.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12326.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16973.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12326.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12258.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12326.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12326.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12153.51,"maximum":21997.3,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21997.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17520.56},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14949.58},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12404.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12590.96},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14873.74},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17109.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16727.27},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12220.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12831.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20775.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17534.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12428.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17522.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12220.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12153.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12220.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13900.02,"maximum":25553.32,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25553.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19342.15},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16503.87},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14409.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13900.02},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16420.15},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19874.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18466.39},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14196.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14906.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24133.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19357.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14437.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19343.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14196.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14118.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14196.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12673.96,"10th_percentile":12673.96,"90th_percentile":12673.96,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11747.58,"maximum":21512.74,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21512.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16346.98},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13948.21},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12130.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11747.58},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13877.45},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16732.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15606.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11951.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20317.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16359.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16348.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11951.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11885.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11951.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":16348.13,"10th_percentile":16348.13,"90th_percentile":16348.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5921.93,"maximum":11223.29,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11223.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8240.48},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7031.27},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6328.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5921.93},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6995.6},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6235.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8729.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7867.38},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6235.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6546.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10599.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8246.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6341.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6235.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6235.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8241.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6235.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6200.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6235.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6235.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7730.4,"10th_percentile":7730.4,"90th_percentile":7730.4,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8925.76,"10th_percentile":8925.76,"90th_percentile":8925.76,"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":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":5488.96,"10th_percentile":5488.96,"90th_percentile":5488.96,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":13493.27,"10th_percentile":13493.27,"90th_percentile":13493.27,"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":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":7826.24,"10th_percentile":7826.24,"90th_percentile":7826.24,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":1107.0,"10th_percentile":1107.0,"90th_percentile":1107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2398.98,"10th_percentile":2398.98,"90th_percentile":2398.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14594.4,"maximum":26415.2,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26415.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20822.99},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17767.41},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14895.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14964.21},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17677.28},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14675.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20545.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19880.18},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14675.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15408.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24947.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20839.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14924.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14675.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14675.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20824.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14675.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14594.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14675.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14675.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":960.0,"10th_percentile":560.0,"90th_percentile":2192.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":1239.7,"10th_percentile":1239.7,"90th_percentile":1239.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4828.49,"10th_percentile":4828.49,"90th_percentile":4828.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":586.08,"10th_percentile":586.08,"90th_percentile":586.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":1961.0,"10th_percentile":1764.9,"90th_percentile":3137.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4797.96,"10th_percentile":4797.96,"90th_percentile":4797.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8037.03,"maximum":15800.06,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15800.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11183.68},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9542.58},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8909.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8037.03},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9494.17},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8777.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12288.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10677.31},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8777.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14922.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11192.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8927.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8777.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8777.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11184.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8777.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8777.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8777.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8283.57,"maximum":16843.3,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16843.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11526.74},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9835.3},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9497.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8283.57},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9785.41},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13100.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11004.84},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9357.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9825.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15907.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11535.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9516.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11527.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9357.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9305.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9357.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":7025.83,"10th_percentile":7025.83,"90th_percentile":7025.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":4957.73,"10th_percentile":4957.73,"90th_percentile":6447.21,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5532.29,"10th_percentile":5532.29,"90th_percentile":5532.29,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5896.89,"10th_percentile":5896.89,"90th_percentile":5896.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":6758.0,"10th_percentile":6758.0,"90th_percentile":8926.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4797.96,"10th_percentile":4797.96,"90th_percentile":4797.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12568.98,"maximum":22749.28,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22749.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17879.79},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15256.1},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12828.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12849.12},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15178.71},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12638.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17693.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17070.24},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12638.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13270.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21485.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17893.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12853.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12638.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12638.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17881.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12638.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12568.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12638.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12638.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":17880.95,"10th_percentile":17880.95,"90th_percentile":17880.95,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12027.02,"10th_percentile":12027.02,"90th_percentile":12027.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12024.65,"10th_percentile":12024.65,"90th_percentile":12024.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17786.49,"maximum":32192.75,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32192.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25784.14},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22000.56},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18153.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18529.49},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21888.95},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17884.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25038.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24616.7},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17884.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18779.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30404.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25804.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18188.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17884.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17884.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25786.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17884.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17786.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17884.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17884.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":24526.18,"maximum":44391.28,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44391.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35618.66},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":30391.96},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25031.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25596.96},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30237.78},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24661.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34526.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34005.94},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24661.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25894.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41925.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35646.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25081.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24661.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24661.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35621.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24661.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24526.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":24661.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24661.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":30374.85,"10th_percentile":30374.85,"90th_percentile":30374.85,"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":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":35624.06,"10th_percentile":35624.06,"90th_percentile":35624.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22907.08,"10th_percentile":22907.08,"90th_percentile":22907.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":36553.6,"maximum":66160.37,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66160.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":57833.55},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":49347.02},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37307.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":41561.45},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49096.68},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36755.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51458.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55214.99},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36755.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38593.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62484.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57878.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37380.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36755.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36755.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57838.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":36755.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36553.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":36755.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36755.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6945.45,"maximum":13830.08,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13830.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9664.72},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8246.52},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7798.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6945.45},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8204.68},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7683.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10756.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9227.13},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7683.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8067.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13061.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9672.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7814.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7683.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7683.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9665.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7683.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7641.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7683.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7683.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12363.44,"maximum":22377.26,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22377.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18776.15},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16020.93},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12618.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13493.28},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15939.65},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12431.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17404.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17926.01},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12431.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13053.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21134.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18790.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12643.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12431.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12431.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18777.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12431.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12363.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12431.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12431.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7343.89,"maximum":14068.39,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14068.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10219.17},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8719.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7933.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7343.89},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8675.37},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10942.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9756.47},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7815.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8206.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13286.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10227.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7948.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10220.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7815.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7772.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7815.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9938.33,"10th_percentile":9938.33,"90th_percentile":9938.33,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7957.34,"maximum":15267.85,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15267.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11072.79},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9447.96},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8609.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7957.34},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9400.03},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8482.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11875.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10571.44},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8482.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8906.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14419.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11081.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8626.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8482.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8482.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11073.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8482.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8482.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8482.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9380.24,"10th_percentile":9380.24,"90th_percentile":9380.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7865.04,"10th_percentile":7865.04,"90th_percentile":7865.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":762.31,"10th_percentile":762.31,"90th_percentile":762.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4582.5,"10th_percentile":4582.5,"90th_percentile":4582.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7865.51,"10th_percentile":7865.51,"90th_percentile":7865.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5180.65,"maximum":10722.85,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10722.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7208.98},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6151.13},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6046.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5180.65},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6119.92},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5957.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8340.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6882.57},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5957.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6255.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10127.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7214.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6058.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5957.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5957.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7209.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5957.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5924.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":5957.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5957.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5918.91,"10th_percentile":5918.91,"90th_percentile":5918.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9435.95,"10th_percentile":9435.95,"90th_percentile":9435.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":1005.0,"10th_percentile":1005.0,"90th_percentile":1005.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12262.49,"maximum":22194.56,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22194.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19037.2},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16243.67},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12515.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13680.88},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16161.27},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17262.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18175.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12330.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12946.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20961.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19052.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12539.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19038.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12330.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12262.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12330.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5511.86,"maximum":11376.86,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11376.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7669.86},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6544.38},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6415.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5511.86},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6511.18},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6320.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8848.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7322.59},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6320.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6636.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10744.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7675.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6427.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6320.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6320.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7670.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6320.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6285.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6320.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6320.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7671.02,"10th_percentile":7671.02,"90th_percentile":7671.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":5752.37,"10th_percentile":5752.37,"90th_percentile":5752.37,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":128.33,"10th_percentile":128.33,"90th_percentile":128.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":157582.7,"maximum":285217.56,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":285217.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":274022.06},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":233811.92},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160831.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":196922.96},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":232625.78},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158454.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":221835.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":261615.04},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":158454.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":166376.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":269372.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":274235.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161147.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158454.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158454.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":274045.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":158454.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157582.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":158454.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158454.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16221.81,"maximum":29400.61,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29400.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22572.96},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19260.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16578.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16221.81},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19162.89},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16333.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22867.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21550.92},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16333.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17150.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27767.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22590.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16611.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16333.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16333.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22574.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16333.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16243.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16333.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16333.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":50647.4,"maximum":91669.5,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91669.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":78869.07},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":67295.78},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51691.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":56678.4},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66954.39},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50927.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71298.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75298.08},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50927.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53473.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86576.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78930.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51793.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50927.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50927.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78875.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":50927.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50647.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":50927.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50927.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":46186.95,"maximum":83596.28,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83596.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":73047.37},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":62328.36},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47139.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":52494.69},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62012.16},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46442.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65019.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69739.97},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46442.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48764.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78952.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73104.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47231.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46442.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46442.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73053.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":46442.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46186.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":46442.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46442.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13846.9,"maximum":25247.5,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25247.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19268.22},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16440.79},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14236.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13846.9},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16357.39},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19636.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18395.81},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14026.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14727.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23844.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19283.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19269.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14026.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13949.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14026.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":16440.28,"10th_percentile":16440.28,"90th_percentile":16440.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17358.09,"10th_percentile":17358.09,"90th_percentile":17358.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":96137.73,"maximum":174004.94,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174004.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":150947.31},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":128797.22},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98119.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":108476.64},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":128143.83},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96669.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135337.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144112.8},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96669.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101502.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164338.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151064.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98312.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96669.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96669.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150960.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":96669.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96137.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":96669.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96669.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":41147.18,"maximum":74474.53,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74474.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":69716.06},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":59485.89},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41995.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":50100.69},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59184.11},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41374.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57924.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66559.49},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41374.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70337.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69770.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42078.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41374.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41374.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69722.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":41374.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41147.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":41374.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41374.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":34669.35,"maximum":62749.96,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62749.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51656.07},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":44076.03},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35384.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":37122.07},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43852.43},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34861.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48805.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49317.22},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34861.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36604.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59263.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51696.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35453.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34861.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34861.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51660.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":34861.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34669.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":34861.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34861.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13243.42,"maximum":24570.97,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24570.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18428.47},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15724.26},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13855.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13243.42},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15644.49},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13650.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19110.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17594.07},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13650.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14333.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23205.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18442.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13882.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13650.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13650.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18430.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13650.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13650.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13650.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17494.64,"maximum":31664.5,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31664.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26089.09},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22260.76},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17855.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18748.64},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22147.83},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17591.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24627.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24907.84},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17591.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18470.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29905.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26109.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17890.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17591.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17591.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26091.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17591.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17494.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17591.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17591.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":15610.61,"10th_percentile":15610.61,"90th_percentile":15610.61,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":24171.75,"10th_percentile":24171.75,"90th_percentile":24171.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16900.94,"10th_percentile":16900.94,"90th_percentile":16900.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13916.33,"maximum":25187.92,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25187.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21319.68},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18191.22},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14203.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15321.16},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18098.93},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13993.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19590.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20354.38},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13993.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14692.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23788.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21336.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14231.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13993.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13993.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21321.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13993.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13916.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13993.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13993.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5713.58,"maximum":11616.5,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11616.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7950.55},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6783.88},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6550.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5713.58},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6749.47},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9035.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7590.57},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6776.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10971.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7956.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7951.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6418.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6453.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7712.2,"10th_percentile":7712.2,"90th_percentile":7712.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":6758.55,"10th_percentile":6758.55,"90th_percentile":6758.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5959.2,"10th_percentile":5959.2,"90th_percentile":5959.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11405.22,"10th_percentile":11405.22,"90th_percentile":11405.22,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8652.96,"maximum":16202.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16202.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12040.76},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10273.89},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8652.96},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10221.77},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12601.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11495.59},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9451.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15302.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12050.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9154.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12041.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9001.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9365.42,"10th_percentile":9365.42,"90th_percentile":9880.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6758.46,"10th_percentile":6758.46,"90th_percentile":6758.46,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8338.03,"10th_percentile":8338.03,"90th_percentile":8338.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":9115.9,"10th_percentile":9115.9,"90th_percentile":9115.9,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":7090.69,"10th_percentile":7090.69,"90th_percentile":7090.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8459.82,"10th_percentile":8459.82,"90th_percentile":8459.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18130.28,"maximum":32814.99,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32814.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26799.48},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22866.91},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18504.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19259.15},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22750.9},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18230.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25522.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25586.06},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18230.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19142.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30991.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26820.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18540.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18230.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18230.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26801.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18230.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18130.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18230.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18230.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7115.62,"maximum":13454.08,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13454.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9901.52},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8448.56},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7586.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7115.62},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8405.7},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7474.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10464.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9453.2},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7474.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7848.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12706.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9909.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7601.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7474.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7474.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9902.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7474.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7433.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7474.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7474.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18005.7,"maximum":32938.11,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32938.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25055.27},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21378.65},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18005.7},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21270.19},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18298.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25618.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23920.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18298.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19213.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31108.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25074.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18610.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18298.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18298.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25057.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18298.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18198.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18298.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18298.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12639.2,"maximum":22876.38,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22876.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17683.43},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15088.55},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12708.0},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15012.01},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17792.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16882.77},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12709.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13344.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21605.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17697.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12925.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17684.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12709.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12639.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12709.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17284.71,"maximum":31284.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31284.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27848.31},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":23761.83},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17641.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20012.88},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23641.29},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17380.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24332.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26587.41},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17380.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18249.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29546.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27870.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17675.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17380.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17380.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27850.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17380.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17380.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17380.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11608.95,"maximum":22324.3,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22324.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16154.07},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13783.62},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12588.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11608.95},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13713.69},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12402.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17363.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15422.66},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12402.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13022.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21084.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16166.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12613.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12402.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12402.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16155.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12402.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12334.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12402.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12402.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9834.19,"maximum":18473.04,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18473.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13684.47},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11676.4},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10416.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9834.19},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11617.17},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10262.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14367.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13064.87},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10262.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17446.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13695.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10437.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10262.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10262.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13685.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10262.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10206.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10262.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10262.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":13562.87,"10th_percentile":13562.87,"90th_percentile":13562.87,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5907.82,"maximum":12328.76,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12328.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8220.85},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7014.52},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6952.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5907.82},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6978.93},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9589.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7848.63},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6849.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7191.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11643.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8227.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8221.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6849.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6811.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6849.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7711.98,"10th_percentile":7711.98,"90th_percentile":7711.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3794.42,"10th_percentile":3794.42,"90th_percentile":6872.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":27407.41,"maximum":52157.34,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52157.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38137.94},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":32541.56},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29410.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":27407.41},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32376.47},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28976.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40566.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36411.15},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28976.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30425.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49259.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38167.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29468.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28976.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28976.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38141.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28976.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28816.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":28976.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28976.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6292.16,"maximum":12273.16,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12273.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8755.66},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7470.85},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6920.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6292.16},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7432.95},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6818.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9545.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8359.22},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6818.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7159.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11591.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8762.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6934.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6818.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6818.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8756.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6818.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6780.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6818.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6818.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4361.78,"10th_percentile":4361.78,"90th_percentile":4361.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5475.34,"maximum":11935.57,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11935.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7619.04},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6501.02},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6730.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5475.34},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6468.04},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6630.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9283.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7274.07},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6630.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6962.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11272.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7624.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6743.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6630.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6630.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7619.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6630.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6594.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6630.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6630.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5433.74,"10th_percentile":5433.74,"90th_percentile":5433.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":35329.86,"maximum":63945.45,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63945.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":56009.64},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":47790.76},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36058.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":40250.72},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47548.31},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35525.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49735.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53473.67},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35525.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37301.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60392.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56053.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36129.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35525.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35525.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56014.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":35525.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":35525.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35525.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":44785.47,"maximum":81059.67,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81059.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":69716.06},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":59485.89},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45708.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":50100.69},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59184.11},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45033.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63046.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66559.49},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45033.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47284.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76556.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69770.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45798.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45033.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45033.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69722.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":45033.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44785.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":45033.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45033.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":30026.03,"maximum":54345.76,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54345.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43909.97},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":37466.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30644.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":31555.42},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37276.53},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30192.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42268.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41921.84},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30192.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31701.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51326.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43944.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30705.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30192.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30192.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43913.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":30192.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30026.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":30192.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30192.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16999.44,"maximum":30768.21,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30768.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24667.16},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21047.49},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17349.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17726.79},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20940.71},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17093.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23930.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23550.29},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17093.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17948.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29058.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24686.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17093.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17093.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24669.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17093.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16999.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17093.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17093.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":29655.18,"maximum":53674.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53674.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43568.06},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":37174.86},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30266.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":31309.71},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36986.27},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29819.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41746.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41595.41},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29819.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31310.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50692.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43602.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30326.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29819.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29819.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43571.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":29819.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29655.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":29819.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29819.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10888.81,"maximum":19708.25,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19708.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15417.12},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13154.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11113.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11079.34},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13088.07},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15328.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14719.07},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10949.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11496.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18613.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15429.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15418.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10949.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10888.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10949.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10520.69,"10th_percentile":10520.69,"90th_percentile":10520.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":11572.1,"10th_percentile":11572.1,"90th_percentile":11572.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10441.13,"10th_percentile":10441.13,"90th_percentile":10481.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8442.12,"maximum":15931.13,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15931.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11747.37},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10023.55},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8983.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8442.12},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9972.7},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12390.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11215.48},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8850.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9293.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15046.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11756.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9001.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11748.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8850.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8801.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8850.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10773.49,"10th_percentile":10773.49,"90th_percentile":11958.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8286.93,"10th_percentile":8286.93,"90th_percentile":8286.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":9735.6,"10th_percentile":9735.6,"90th_percentile":9735.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6371.77,"10th_percentile":6371.77,"90th_percentile":8246.71,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":12638.53,"10th_percentile":12638.53,"90th_percentile":12638.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":11071.49,"10th_percentile":11071.49,"90th_percentile":11071.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":8248.57,"10th_percentile":6643.17,"90th_percentile":8764.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8366.24,"10th_percentile":8366.24,"90th_percentile":8366.24,"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":"Wellcare","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":8598.66,"10th_percentile":8598.66,"90th_percentile":8598.66,"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":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12829.2,"maximum":23795.17,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23795.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17852.07},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15232.45},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13417.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12829.2},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15155.17},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13219.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18507.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17043.77},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13219.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13880.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22473.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17865.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13444.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13219.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13219.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17853.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13219.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13146.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13219.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13219.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10429.93,"10th_percentile":10429.93,"90th_percentile":10429.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7510.74,"maximum":14412.6,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14412.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10451.34},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8917.71},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8127.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7510.74},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.47},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11209.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9978.13},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8007.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8407.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13611.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10459.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8143.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10452.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8007.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7962.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8007.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8899.5,"maximum":17100.14,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17100.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12383.83},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10566.62},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9642.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8899.5},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10513.01},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13300.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11823.12},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9500.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9975.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16150.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12393.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12384.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9500.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9447.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9500.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9500.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":789.54,"10th_percentile":789.54,"90th_percentile":789.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":27830.92,"maximum":50372.71,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50372.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41408.02},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":35331.79},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28404.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29757.42},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35152.55},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27984.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39178.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39533.17},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27984.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29384.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47574.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41440.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28460.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27984.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27984.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41411.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27984.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27830.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":27984.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27984.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9812.61,"maximum":20468.18,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20468.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13654.44},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11650.78},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11541.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9812.61},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11591.67},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11371.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15919.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13036.2},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11371.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19331.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13665.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11564.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11371.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11371.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13655.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11371.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11308.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11371.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11371.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6854.14,"maximum":12720.64,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12720.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9537.66},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8138.1},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7173.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6854.14},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8096.81},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7067.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9893.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9105.82},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7067.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12013.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9545.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7187.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7067.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7067.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9538.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7067.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7028.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7067.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7067.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7060.03,"10th_percentile":7060.03,"90th_percentile":7060.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13051.66,"maximum":23690.57,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23690.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18161.64},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15496.59},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13358.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13051.66},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15417.97},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13161.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18426.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17339.32},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13161.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22374.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18175.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13385.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13161.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13161.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18163.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13161.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13089.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13161.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13161.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11151.4,"maximum":20183.53,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20183.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15964.64},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13621.98},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11381.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11472.81},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13552.87},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15698.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15241.8},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11213.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11773.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19062.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15977.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11403.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15966.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11213.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11151.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11213.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7807.09,"maximum":14600.59,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14600.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10863.72},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9269.57},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8233.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7807.09},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9222.54},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8111.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11356.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10371.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8111.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13789.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10872.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8249.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8111.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8111.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10864.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8111.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8066.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8111.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8111.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":7176.17,"10th_percentile":7176.17,"90th_percentile":7176.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8016.21,"10th_percentile":8016.21,"90th_percentile":8016.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11459.35,"maximum":20740.9,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20740.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16276.51},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13888.09},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11695.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11696.94},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13817.63},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11522.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16131.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15539.55},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11522.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12098.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19588.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16289.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11718.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11522.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11522.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16277.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11522.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11459.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11522.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11522.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":17120.33,"10th_percentile":17120.33,"90th_percentile":17120.33,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":5442.65,"10th_percentile":5442.65,"90th_percentile":5442.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10768.58,"10th_percentile":10768.58,"90th_percentile":10982.56,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11052.96,"10th_percentile":6835.96,"90th_percentile":11408.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12602.62,"maximum":22810.18,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22810.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18333.75},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15643.44},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12862.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13175.35},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15564.08},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12672.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17741.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17503.64},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12672.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13305.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21542.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18348.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12887.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12672.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12672.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18335.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12672.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12602.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12672.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12672.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12312.53,"10th_percentile":12312.53,"90th_percentile":12312.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7131.39,"maximum":13716.22,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13716.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9923.46},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8467.29},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7734.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7131.39},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8424.33},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10668.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9474.15},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8001.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12954.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9931.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7749.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9924.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7578.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7620.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7122.19,"10th_percentile":317.72,"90th_percentile":7674.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14315.71,"maximum":25910.78,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25910.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20389.83},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17397.81},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14610.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14652.93},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17309.55},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20152.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19466.63},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14394.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15114.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24471.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20405.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14639.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20391.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14394.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14315.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14394.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":13615.13,"10th_percentile":13615.13,"90th_percentile":13615.13,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":27367.36,"10th_percentile":27367.36,"90th_percentile":27367.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13514.89,"10th_percentile":13267.68,"90th_percentile":13587.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":48479.35,"maximum":87745.43,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87745.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":74708.4},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":63745.65},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49478.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":53688.38},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63422.27},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48747.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68246.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71325.8},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48747.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51184.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82870.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74766.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49576.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48747.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48747.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74714.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":48747.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48479.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":48747.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48747.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":86727.6,"10th_percentile":86727.6,"90th_percentile":86727.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46708.47,"10th_percentile":46708.47,"90th_percentile":46708.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":40419.37,"maximum":73157.24,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73157.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61177.56},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":52200.33},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41252.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":43964.59},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51935.52},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40642.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56900.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58407.6},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40642.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42675.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69092.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61225.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41333.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40642.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40642.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61182.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":40642.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40419.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":40642.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40642.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":44338.55,"maximum":80250.77,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80250.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":67963.77},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":57990.73},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45252.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":48841.42},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57696.54},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44583.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62417.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64886.55},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44583.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46812.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75792.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68016.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45341.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44583.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44583.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67969.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":44583.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44338.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":44583.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44583.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":34784.2,"maximum":62957.83,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62957.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":56443.96},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":48161.34},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35501.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":40562.84},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47917.02},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34976.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48967.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53888.32},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34976.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36725.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59460.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56487.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35571.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34976.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34976.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56448.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":34976.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34784.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":34976.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34976.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7403.66,"maximum":17015.42,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17015.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10302.34},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8790.57},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9594.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7403.66},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8745.97},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9453.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13234.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9835.87},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9453.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9925.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16070.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10310.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9613.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9453.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9453.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10303.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9453.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9401.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9453.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9453.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":27877.73,"maximum":50457.44,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50457.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41201.26},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":35155.37},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28452.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29608.84},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34977.02},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28031.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39244.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39335.77},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28031.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47654.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41233.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28508.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28031.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28031.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41204.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28031.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27877.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":28031.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28031.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":19874.08,"maximum":35971.18,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35971.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29071.56},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":24805.58},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20283.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20891.96},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24679.74},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19983.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27977.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27755.27},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19983.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20983.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33972.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29094.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20323.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19983.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19983.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29074.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19983.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19874.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19983.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19983.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":28905.03,"10th_percentile":28905.03,"90th_percentile":28905.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18632.24,"10th_percentile":18632.24,"90th_percentile":18632.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18883.83,"10th_percentile":18883.83,"90th_percentile":18883.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12842.55,"maximum":23244.43,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23244.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18672.19},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15932.22},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13107.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13418.57},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15851.4},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12913.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18079.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17826.76},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12913.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13559.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21953.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18686.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13133.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12913.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12913.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18673.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12913.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12842.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12913.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12913.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":212.5,"10th_percentile":212.5,"90th_percentile":212.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12903.19,"10th_percentile":12538.37,"90th_percentile":24835.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2537.62,"10th_percentile":2537.62,"90th_percentile":2537.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6901.99,"10th_percentile":5929.97,"90th_percentile":12461.68,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6297.33,"10th_percentile":6297.33,"90th_percentile":12325.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":21892.56,"10th_percentile":21892.56,"90th_percentile":21892.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":11380.0,"10th_percentile":7974.56,"90th_percentile":12607.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12855.44,"10th_percentile":12855.44,"90th_percentile":12855.44,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6454.86,"maximum":12968.21,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12968.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8982.06},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7664.03},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7312.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6454.86},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7625.15},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10086.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8575.37},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7204.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12247.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8989.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7327.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8982.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7204.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7164.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7204.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":6741.73,"10th_percentile":6741.73,"90th_percentile":6741.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10939.06,"maximum":19957.14,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19957.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15221.91},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12988.24},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11253.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10939.06},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12922.35},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11087.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15522.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14532.7},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11087.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11641.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18848.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15233.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11275.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11087.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11087.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15223.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11087.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11026.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11087.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11087.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":13377.05,"10th_percentile":7663.2,"90th_percentile":15182.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":15220.75,"10th_percentile":15220.75,"90th_percentile":15220.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":10326.38,"10th_percentile":8980.47,"90th_percentile":10425.97,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10109.56,"10th_percentile":10109.56,"90th_percentile":10109.56,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":15220.75,"10th_percentile":15220.75,"90th_percentile":15220.75},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":14265.31,"10th_percentile":14265.31,"90th_percentile":14265.31,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":4988.55,"10th_percentile":4988.55,"90th_percentile":4988.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":14531.6,"10th_percentile":14531.6,"90th_percentile":14531.6,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":9057.36,"10th_percentile":9057.36,"90th_percentile":9057.36,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10282.69,"10th_percentile":10282.69,"90th_percentile":17447.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":8887.16,"10th_percentile":8887.16,"90th_percentile":8887.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":16801.65,"10th_percentile":4141.5,"90th_percentile":16837.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"45","median_amount":8869.04,"10th_percentile":5494.53,"90th_percentile":10830.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10481.52,"10th_percentile":10481.52,"90th_percentile":10481.52,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5618.95,"maximum":12022.94,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12022.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7818.87},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6671.53},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6779.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5618.95},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6637.68},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9351.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7464.85},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6679.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7013.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11355.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7824.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6792.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7819.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6679.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6642.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6679.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":5565.81,"10th_percentile":5565.81,"90th_percentile":5565.81,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":80951.86,"maximum":146519.21,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":146519.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":125826.2},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":107362.39},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82620.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":90423.62},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":106817.74},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81399.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113959.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120129.11},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81399.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85469.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138379.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125924.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82783.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81399.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81399.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125837.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":81399.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80951.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":81399.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81399.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":37600.32,"maximum":68054.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68054.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":57557.48},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":49111.46},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38375.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":41363.05},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48862.32},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37808.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52931.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54951.42},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37808.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39698.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64274.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57602.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38451.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37808.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37808.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57562.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":37808.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37600.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":37808.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37808.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":88372.31,"10th_percentile":88372.31,"90th_percentile":88372.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":37412.33,"maximum":67714.63,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67714.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58176.61},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":49639.74},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38183.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":41807.99},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49387.92},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37619.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52666.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55542.52},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37619.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39500.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63952.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58221.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38258.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37619.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37619.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58181.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":37619.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37412.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":37619.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37619.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":48127.87,"10th_percentile":48127.87,"90th_percentile":48127.87,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12343.68,"maximum":22341.51,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22341.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18048.44},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15400.0},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12598.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12970.31},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15321.88},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17376.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17231.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12411.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13032.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21100.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18062.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12622.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18050.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12411.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12343.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12411.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12241.44,"10th_percentile":12241.44,"90th_percentile":12241.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14589.84,"maximum":29326.46,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29326.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20302.04},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17322.91},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16536.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14589.84},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17235.03},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16292.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22809.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19382.81},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16292.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27697.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20317.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16569.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16292.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16292.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20303.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16292.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16292.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16292.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":36235.41,"maximum":65584.46,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65584.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54340.52},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":46366.57},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36982.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":39051.22},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46131.35},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36435.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51010.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51880.12},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36435.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38257.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61940.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54382.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37055.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36435.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36435.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54345.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":36435.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36235.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":36435.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36435.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":53568.13,"maximum":96955.88,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96955.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":81625.14},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":69647.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54672.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":58659.02},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69294.1},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53864.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75410.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77929.36},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53864.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56557.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91569.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81688.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54780.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53864.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53864.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81632.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":53864.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53568.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":53864.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53864.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15900.78,"maximum":28779.7,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28779.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22586.83},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19272.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16228.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16231.78},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19174.65},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15988.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22384.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21564.15},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15988.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16788.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27180.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22604.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16260.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15988.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15988.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22588.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15988.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15900.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15988.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15988.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15654.97,"10th_percentile":15654.97,"90th_percentile":15654.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10802.5,"maximum":19552.03,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19552.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15072.9},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12861.09},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11025.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10831.97},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12795.85},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15207.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14390.44},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10862.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11405.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18465.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15084.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11046.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15074.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10862.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10802.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10862.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":11752.59,"10th_percentile":10838.78,"90th_percentile":15042.05,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":9497.73,"10th_percentile":1294.12,"90th_percentile":10757.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":3569.98,"10th_percentile":3569.98,"90th_percentile":3569.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":11060.67,"10th_percentile":5948.06,"90th_percentile":23521.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":13859.33,"10th_percentile":13859.33,"90th_percentile":13859.33,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":8637.08,"10th_percentile":840.57,"90th_percentile":9451.88,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5704.51,"10th_percentile":5704.51,"90th_percentile":5704.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":17840.55,"10th_percentile":11262.14,"90th_percentile":20683.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":12033.97,"10th_percentile":12033.97,"90th_percentile":12033.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"45","median_amount":10302.49,"10th_percentile":8372.74,"90th_percentile":10656.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10814.5,"10th_percentile":10814.5,"90th_percentile":10814.5,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13354.56,"maximum":24171.16,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24171.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18686.05},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15944.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13629.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13428.53},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15863.17},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13428.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18799.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17840.0},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13428.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14099.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22828.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18700.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13656.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13428.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13428.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18687.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13428.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13354.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13428.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13428.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":15848.18,"10th_percentile":15848.18,"90th_percentile":15848.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10783.25,"10th_percentile":10783.25,"90th_percentile":10783.25,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12543.68,"10th_percentile":12543.68,"90th_percentile":12543.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7689.22,"maximum":14645.61,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14645.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10699.69},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9129.61},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8258.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7689.22},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9083.3},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11391.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10215.24},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8136.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13831.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10708.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8274.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10700.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8136.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8091.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8136.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7726.94,"10th_percentile":7726.94,"90th_percentile":7726.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7988.05,"maximum":15308.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15308.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11115.53},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9484.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8632.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7988.05},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9436.31},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11906.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10612.24},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8504.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8930.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14458.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11124.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8649.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11116.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8504.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8504.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":11285.53,"10th_percentile":11285.53,"90th_percentile":11285.53,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7847.9,"10th_percentile":7847.9,"90th_percentile":7847.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":11181.25,"10th_percentile":11181.25,"90th_percentile":11181.25,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2799.58,"10th_percentile":2799.58,"90th_percentile":2799.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7839.17,"10th_percentile":7839.17,"90th_percentile":7895.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8469.11,"10th_percentile":8469.11,"90th_percentile":8469.11,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":24460.34,"maximum":44272.12,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44272.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36905.45},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":31489.92},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24964.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":26521.7},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31330.17},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34433.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35234.46},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25825.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41812.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36934.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25013.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36908.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24460.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":24595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24595.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":27896.02,"maximum":50490.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50490.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40064.64},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":34185.54},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28471.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":28792.02},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34012.11},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28050.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39270.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38250.62},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28050.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29452.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47685.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40095.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28527.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28050.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28050.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40068.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28050.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27896.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":28050.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28050.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10088.59,"maximum":18259.88,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18259.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14383.31},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12272.69},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10296.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10336.41},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12210.43},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10144.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14202.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13732.07},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10144.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10651.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17245.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14394.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10144.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10144.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14384.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10144.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10144.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10144.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13718.1,"maximum":24829.15,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24829.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19649.41},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16766.04},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14000.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14120.83},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16680.99},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13793.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19311.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18759.73},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13793.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14483.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23449.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19664.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13793.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13793.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19651.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13793.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13718.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13793.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13793.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12844.1,"10th_percentile":12844.1,"90th_percentile":12844.1,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":19471.24,"10th_percentile":19471.24,"90th_percentile":19471.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1425.05,"10th_percentile":1425.05,"90th_percentile":1425.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4645.54,"10th_percentile":4645.54,"90th_percentile":4645.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14381.53,"maximum":26029.93,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26029.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20194.61},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17231.24},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14677.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14512.64},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17143.83},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14461.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20245.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19280.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14461.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15184.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24583.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20210.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14706.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14461.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14461.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20196.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14461.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14381.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14461.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14461.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12903.27,"10th_percentile":12903.27,"90th_percentile":12903.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","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":13900.79,"10th_percentile":13900.79,"90th_percentile":13900.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14316.02,"10th_percentile":14316.02,"90th_percentile":14316.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5284.42,"maximum":10901.59,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10901.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7353.37},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6274.33},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6147.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5284.42},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6242.5},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8479.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7020.42},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6056.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6359.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7359.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6159.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7354.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6056.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6023.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6056.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":5544.85,"10th_percentile":5544.85,"90th_percentile":5544.85,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5564.16,"maximum":11575.46,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11575.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7742.64},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6606.48},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6527.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5564.16},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6572.96},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6430.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9003.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7392.07},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6430.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6752.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10932.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7748.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6540.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6430.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6430.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7743.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6430.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6395.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6430.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6430.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5282.76,"maximum":11147.83,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11147.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7351.06},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6272.36},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6286.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5282.76},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6240.54},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8670.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7018.22},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6193.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6502.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10528.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7356.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6298.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6193.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6159.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6193.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":6729.75,"10th_percentile":6729.75,"90th_percentile":6729.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":27492.98,"maximum":49761.05,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49761.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40441.21},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":34506.84},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28059.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29062.63},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34331.79},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27645.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38703.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38610.13},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27645.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29027.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46996.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40472.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28115.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27645.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27645.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40444.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27645.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27492.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":27645.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27645.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11374.03,"maximum":20604.55,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20604.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15827.18},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13504.69},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11618.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11374.03},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13436.18},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16025.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15110.57},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11446.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12019.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19459.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15839.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11641.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15828.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11446.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11384.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11446.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10879.04,"10th_percentile":10879.04,"90th_percentile":10879.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17415.64,"maximum":31521.53,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31521.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26372.09},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22502.23},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17774.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18952.01},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22388.08},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24516.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25178.03},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17511.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18387.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29770.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26392.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17809.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26374.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17511.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17415.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17511.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8879.58,"maximum":16538.8,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16538.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12356.1},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10542.96},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9326.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8879.58},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10489.48},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9188.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12863.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11796.65},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9188.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9647.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15619.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12365.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9188.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9188.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12357.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9188.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9137.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9188.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9188.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":13637.84,"10th_percentile":13637.84,"90th_percentile":13637.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8640.3,"10th_percentile":6722.66,"90th_percentile":9098.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14539.53,"maximum":26315.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26315.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21834.86},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18630.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14839.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15691.38},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18536.28},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20467.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20846.23},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14619.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15350.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24853.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21851.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14868.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21836.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14619.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14539.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14619.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":40395.97,"maximum":73114.88,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73114.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":59484.18},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":50755.44},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41228.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":42747.66},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50497.96},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40619.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56867.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56790.89},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40619.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42650.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69052.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59530.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41309.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40619.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40619.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59489.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":40619.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40395.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":40619.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40619.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":24194.82,"maximum":43791.53,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43791.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34059.28},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":29061.4},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24693.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24476.33},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28913.97},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24328.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34060.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32517.16},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24328.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25545.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41358.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34085.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24742.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24328.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24328.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34062.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24328.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24194.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":24328.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24328.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":308402.94,"10th_percentile":308402.94,"90th_percentile":308402.94,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":30502.38,"10th_percentile":30502.38,"90th_percentile":30502.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21773.48,"10th_percentile":21773.48,"90th_percentile":21795.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":24373.55,"10th_percentile":24373.55,"90th_percentile":24373.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":22961.58,"maximum":41559.43,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41559.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33463.25},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":28552.83},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23434.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24048.0},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28407.98},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23088.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32324.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31948.12},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23088.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24243.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39250.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33489.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23481.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23088.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23088.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33466.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23088.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22961.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":23088.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23088.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21255.71,"10th_percentile":21255.71,"90th_percentile":21255.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":38811.93,"10th_percentile":38811.93,"90th_percentile":38811.93,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":21521.94,"10th_percentile":21521.94,"90th_percentile":21521.94,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":40587.18,"10th_percentile":40587.18,"90th_percentile":40587.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2398.98,"10th_percentile":2398.98,"90th_percentile":2398.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21537.46,"10th_percentile":21526.2,"90th_percentile":22792.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21487.31,"10th_percentile":21487.31,"90th_percentile":21487.31,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":22714.35,"maximum":41111.95,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41111.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33971.49},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":28986.5},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23182.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24413.24},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28839.45},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22839.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31975.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32433.35},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22839.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23981.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38827.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33997.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23228.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22839.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22839.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33974.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22839.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22714.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":22839.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22839.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":23561.93,"10th_percentile":23561.93,"90th_percentile":23561.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21673.67,"10th_percentile":21673.67,"90th_percentile":21678.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9580.95,"maximum":17341.09,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17341.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14307.07},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12207.64},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9778.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10281.62},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12145.71},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9633.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13487.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13659.28},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9633.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10115.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16377.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14318.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9797.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9633.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9633.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14308.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9633.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9580.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9633.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9633.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9917.91,"10th_percentile":9917.91,"90th_percentile":9917.91,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9635.8,"maximum":29229.82,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29229.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13408.4},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11440.84},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16482.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9635.8},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11382.8},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16238.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22734.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12801.3},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16238.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17050.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27605.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13418.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16514.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16238.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16238.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13409.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16238.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16149.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16238.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16238.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14625.12,"maximum":26470.8,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26470.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22386.99},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19101.91},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14926.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16088.17},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19005.01},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14706.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20588.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21373.37},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14706.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15441.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25000.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22404.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14956.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14706.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14706.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22388.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14706.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14625.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14706.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14706.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":24722.94,"maximum":44747.41,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44747.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35718.0},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":30476.72},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25232.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25668.35},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30322.11},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24859.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34803.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34100.78},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24859.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26102.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42261.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35745.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25282.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24859.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24859.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35721.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24859.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24722.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":24859.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24859.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":13562.19,"10th_percentile":13562.19,"90th_percentile":13562.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22750.78,"10th_percentile":22750.78,"90th_percentile":22750.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12657.36,"maximum":23310.61,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23310.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17612.96},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15028.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13144.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12657.36},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14952.19},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18130.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16815.49},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12950.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13597.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22015.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17626.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13170.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17614.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12950.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12879.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12950.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7171.52,"maximum":12980.12,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12980.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10104.81},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8622.03},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7319.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7261.71},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8578.29},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7211.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10095.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9647.29},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7211.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7571.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12259.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10112.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7333.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7211.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7211.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10105.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7211.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7171.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7211.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7211.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10002.71,"maximum":18537.91,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18537.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13918.96},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11876.48},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10453.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10002.71},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11816.23},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10298.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14418.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13288.74},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10298.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10813.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17508.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13929.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10473.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10298.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10298.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13920.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10298.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10242.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10298.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10298.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12288.09,"maximum":22240.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22240.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17900.58},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15273.84},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12541.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12864.06},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15196.36},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12356.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17298.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17090.09},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12356.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12973.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21005.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17914.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12566.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12356.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12356.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17902.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12356.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12356.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12356.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12066.12,"10th_percentile":12066.12,"90th_percentile":12066.12,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12103.14,"10th_percentile":12103.14,"90th_percentile":12103.14,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8463.7,"maximum":15455.84,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15455.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11777.4},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10049.18},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8715.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8463.7},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9998.2},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8586.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12021.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11244.15},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8586.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9015.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14597.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11786.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8732.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8586.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8586.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11778.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8586.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8539.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8586.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8586.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9144.73,"10th_percentile":9144.73,"90th_percentile":9144.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":34411.79,"10th_percentile":34411.79,"90th_percentile":34411.79,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":7115.29,"10th_percentile":7115.29,"90th_percentile":7115.29,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2236.79,"10th_percentile":2236.79,"90th_percentile":2236.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7450.3,"10th_percentile":7450.3,"90th_percentile":7450.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":37262.38,"maximum":67443.23,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67443.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":62316.49},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":53172.13},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38030.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":44783.06},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52902.39},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37468.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52455.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59494.96},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37468.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39341.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63696.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62365.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38105.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37468.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37468.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62321.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":37468.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37262.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":37468.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37468.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16994.64,"maximum":30896.64,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30896.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23648.36},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":20178.19},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17422.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16994.64},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20075.82},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17164.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24030.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22577.62},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17164.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18023.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29180.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23666.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17456.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17164.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17164.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23650.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17164.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17070.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17164.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17164.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8955.95,"maximum":17533.06,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17533.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12462.37},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10633.64},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9886.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8955.95},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10579.69},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13636.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11898.11},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10227.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16559.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12472.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12463.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9426.1,"10th_percentile":9426.1,"90th_percentile":9426.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12480.47,"maximum":22589.08,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22589.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18598.27},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15869.15},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12737.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13365.44},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15788.64},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17569.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17756.18},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12549.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13176.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21334.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18612.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12762.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18599.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12549.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12480.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12549.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13117.57,"maximum":23742.22,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23742.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18445.79},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15739.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13387.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13255.87},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15659.2},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13190.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18466.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17610.61},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13190.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13849.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22423.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18460.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13190.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13190.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18447.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13190.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13117.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13190.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13190.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":28672.1,"maximum":51895.21,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51895.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45583.71},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":38894.73},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29263.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":32758.24},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38697.42},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28830.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40362.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43519.8},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28830.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49012.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45619.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29320.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28830.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28830.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45587.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28830.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28672.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":28830.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28830.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":27547.34,"10th_percentile":27547.34,"90th_percentile":27547.34,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10302.37,"maximum":21382.99,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21382.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14335.95},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12232.28},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12057.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10302.37},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12170.23},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16631.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13686.85},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11879.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20195.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14347.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12081.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14337.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11879.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11814.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11879.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11879.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":14335.95,"10th_percentile":14335.95,"90th_percentile":14335.95,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":21887.79,"maximum":39615.91,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39615.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32595.77},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":27812.65},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22338.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":23424.59},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27671.55},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22008.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30812.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31119.91},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22008.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23109.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37415.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32621.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22382.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22008.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22008.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32598.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22008.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21887.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":22008.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22008.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":23805.68,"maximum":43087.21,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43087.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36032.19},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":30744.81},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24296.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25894.14},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30588.84},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23937.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33512.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34400.74},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23937.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25134.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40693.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36060.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24344.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23937.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23937.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36035.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23937.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23805.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":23937.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23937.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7932.44,"maximum":15494.24,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15494.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11038.14},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9418.39},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8737.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7932.44},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9370.61},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12051.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10538.36},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8607.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9038.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14633.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11046.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8754.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11039.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8607.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8607.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5042.86,"maximum":10503.09,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10503.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7017.23},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":5987.52},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5922.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5042.86},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5957.15},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5835.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8169.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6699.51},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5835.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6126.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9919.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7022.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5835.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5835.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7017.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5835.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5802.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":5835.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5835.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5403.38,"10th_percentile":5403.38,"90th_percentile":5403.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5413.4,"10th_percentile":5413.4,"90th_percentile":5413.4,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9361.04,"maximum":17698.55,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17698.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13026.06},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11114.61},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9980.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9361.04},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11058.23},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13765.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12436.28},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9832.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10324.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16715.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13036.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9999.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13027.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9832.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9778.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9832.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18433.83,"maximum":33364.4,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33364.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25955.1},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22146.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18813.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18652.35},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22034.08},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18535.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25950.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24779.92},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18535.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19462.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31510.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25975.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18535.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18535.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25957.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18535.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18535.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18535.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15240.27,"maximum":27584.21,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27584.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21431.73},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18286.82},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15554.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15401.68},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18194.05},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15324.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21454.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20461.35},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15324.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16090.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26051.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21448.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15585.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15324.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15324.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21433.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15324.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15324.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15324.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6782.75,"maximum":13295.21,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13295.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9438.32},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8053.34},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7497.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6782.75},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8012.48},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10340.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9010.98},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7386.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7755.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12556.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9445.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7511.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9439.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7386.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7345.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7386.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":27618.8,"maximum":49988.77,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49988.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45981.07},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":39233.78},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28188.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":33043.79},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39034.74},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38880.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43899.16},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29160.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47211.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46016.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28243.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45985.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27618.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":27771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27771.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7700.36,"maximum":13937.31,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13937.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11032.36},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9413.47},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7859.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7928.29},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9365.71},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10840.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10532.84},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7742.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8130.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13163.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11040.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7874.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11033.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7742.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7742.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8461.21,"maximum":15516.74,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15516.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11773.93},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10046.22},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8749.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8461.21},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9995.26},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12068.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11240.84},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8620.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9051.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14654.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11783.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8766.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11774.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8620.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8620.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6120.39,"10th_percentile":6120.39,"90th_percentile":6120.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7565.78,"maximum":13693.72,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13693.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10796.72},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9212.4},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7721.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7758.94},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9165.67},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10650.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10307.87},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7607.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12932.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10805.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10797.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7607.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7565.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7607.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":44886.41,"maximum":81242.37,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81242.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":68670.7},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":58593.92},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45811.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":49349.45},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58296.67},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45134.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63188.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65561.46},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45134.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47391.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68724.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45901.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45134.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45134.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68676.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":45134.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44886.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":45134.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45134.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":2455.2,"10th_percentile":2455.2,"90th_percentile":2455.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":10644.31,"10th_percentile":10644.31,"90th_percentile":10644.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":14775.06,"10th_percentile":14775.06,"90th_percentile":14775.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8037.03,"maximum":15226.81,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15226.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11183.68},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9542.58},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8586.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8037.03},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9494.17},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8459.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11843.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10677.31},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8459.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8882.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14380.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11192.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8603.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8459.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8459.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11184.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8459.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8412.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8459.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8459.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6005.77,"maximum":12537.94,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12537.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8357.15},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7130.82},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6005.77},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7094.64},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9751.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7978.76},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6965.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7313.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11841.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8363.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7083.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8357.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6965.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6927.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6965.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":2378.0,"10th_percentile":2378.0,"90th_percentile":2378.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"19","median_amount":5786.74,"10th_percentile":4671.2,"90th_percentile":6438.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":5364.27,"10th_percentile":5364.27,"90th_percentile":6039.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":3235.84,"10th_percentile":3235.84,"90th_percentile":3235.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4828.49,"10th_percentile":2414.25,"90th_percentile":4997.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":4613.0,"10th_percentile":4613.0,"90th_percentile":4613.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8762.74,"10th_percentile":8762.74,"90th_percentile":8762.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":6225.47,"10th_percentile":5623.19,"90th_percentile":7302.02,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":6798.38,"10th_percentile":6798.38,"90th_percentile":6798.38,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":6622.84,"10th_percentile":6388.1,"90th_percentile":6758.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4797.96,"10th_percentile":2398.98,"90th_percentile":5497.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16967.99,"maximum":30711.29,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30711.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24145.06},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":20602.0},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17317.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17351.58},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20497.48},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17061.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23886.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23051.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17061.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17914.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29005.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24163.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17351.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17061.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17061.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24147.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17061.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16967.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17061.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17061.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":20468.29,"10th_percentile":20468.29,"90th_percentile":20468.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9493.02,"maximum":18495.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18495.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13209.72},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11271.32},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10429.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9493.02},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11214.14},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14385.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12611.62},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10789.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17468.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13220.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10449.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13210.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12139.38,"maximum":22480.52,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22480.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16892.18},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14413.41},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12676.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12139.38},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14340.29},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12489.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17484.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16127.35},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12489.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13113.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21231.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16905.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12701.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12489.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12489.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16893.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12489.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12420.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12489.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12489.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16680.52,"maximum":30190.99,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30190.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23426.58},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19988.95},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17024.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16835.26},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19887.55},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16772.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23481.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22365.89},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16772.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17611.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28513.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23444.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17057.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16772.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16772.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23428.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16772.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16680.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16772.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16772.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":20375.14,"maximum":36878.08,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36878.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29496.63},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":25168.28},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20795.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21197.43},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25040.6},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20487.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28682.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28161.1},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20487.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21512.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34829.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29519.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20836.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20487.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20487.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29499.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20487.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20375.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":20487.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20487.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":34683.98,"maximum":62776.44,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62776.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52110.03},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":44463.37},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35398.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":37448.3},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44237.81},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34875.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48826.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49750.62},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34875.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36619.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59288.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52150.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35468.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34875.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34875.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52114.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":34875.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34683.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":34875.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34875.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32013.89,"10th_percentile":32013.89,"90th_percentile":32013.89,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32894.45,"10th_percentile":32894.45,"90th_percentile":32894.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16722.95,"maximum":30267.77,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30267.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24767.65},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21133.24},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17067.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17799.0},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21026.03},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16815.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23541.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23646.24},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16815.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17656.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28586.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24786.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17101.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16815.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16815.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24769.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16815.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16722.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16815.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16815.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7587.94,"maximum":15012.32,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15012.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10558.77},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9009.37},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8465.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7587.94},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8963.66},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8340.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11676.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10080.69},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8340.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8757.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14178.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10567.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8481.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8340.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8340.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10559.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8340.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8340.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8340.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":3050.64,"10th_percentile":3050.64,"90th_percentile":3406.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5667.15,"10th_percentile":5667.15,"90th_percentile":5667.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8886.22,"10th_percentile":8886.22,"90th_percentile":11596.24,"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":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":4905.52,"10th_percentile":4905.52,"90th_percentile":8821.38,"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 Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":7141.12,"10th_percentile":7141.12,"90th_percentile":7141.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10610.61,"10th_percentile":8828.94,"90th_percentile":14406.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7593.66,"10th_percentile":7593.66,"90th_percentile":7593.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11766.57,"maximum":21296.95,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21296.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16724.69},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14270.5},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12009.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12019.02},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14198.11},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11831.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16564.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15967.44},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11831.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20113.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16737.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12032.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11831.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11831.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16726.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11831.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11766.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11831.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11831.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15780.09,"maximum":28561.25,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28561.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25208.9},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21509.73},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16105.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18116.1},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21400.61},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15867.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22214.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24067.51},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15867.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16660.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26974.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25228.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16137.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15867.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15867.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25211.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15867.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15780.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15867.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15867.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12884.23,"maximum":23319.88,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23319.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18939.02},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16159.9},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13149.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13610.32},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16077.92},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12955.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18137.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18081.51},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12955.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13603.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22024.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18953.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13175.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12955.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12955.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18940.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12955.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12884.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12955.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12955.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":18116.59,"10th_percentile":18116.59,"90th_percentile":18116.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":15907.58,"10th_percentile":15907.58,"90th_percentile":15907.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12663.69,"10th_percentile":12663.69,"90th_percentile":12663.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":26902.36,"10th_percentile":26902.36,"90th_percentile":26902.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8227.74,"10th_percentile":8227.74,"90th_percentile":8227.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11093.4,"10th_percentile":10974.08,"90th_percentile":12699.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":53877.53,"maximum":97515.9,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97515.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":77143.35},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":65823.3},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54988.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":55438.23},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65489.37},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54175.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75845.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73650.5},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54175.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56884.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92098.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77203.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55096.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54175.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54175.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77150.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":54175.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53877.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":54175.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54175.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12670.65,"maximum":23057.75,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23057.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17631.45},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15044.2},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13002.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12670.65},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14967.88},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12809.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17933.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16833.14},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12809.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13450.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21776.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17645.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13027.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12809.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12809.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17632.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12809.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12739.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12809.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12809.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":28936.89,"maximum":52374.46,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52374.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44150.23},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":37671.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29533.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":31728.08},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37480.49},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29096.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40735.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42151.22},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29096.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30551.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49464.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44184.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29591.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29096.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29096.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44154.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":29096.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28936.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":29096.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29096.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":20703.56,"maximum":37472.51,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37472.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30647.11},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":26149.94},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21130.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22024.21},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26017.28},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20818.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29145.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29259.49},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20818.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21858.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35390.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30670.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21171.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20818.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20818.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30649.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20818.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20703.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":20818.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20818.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":26489.42,"maximum":47944.66,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47944.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40463.15},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":34525.57},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27035.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29078.4},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34350.42},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26635.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37290.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38631.08},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26635.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27967.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45281.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40494.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27088.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26635.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26635.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40466.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26635.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26489.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":26635.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26635.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":20583.21,"10th_percentile":20583.21,"90th_percentile":20583.21,"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":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24025.45,"10th_percentile":24025.45,"90th_percentile":24025.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":156666.18,"maximum":283558.7,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":283558.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":247540.24},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":211216.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159895.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":177892.09},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":210144.54},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157532.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":220545.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":236332.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":157532.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165409.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":267805.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":247733.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160210.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157532.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157532.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":247561.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":157532.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156666.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":157532.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157532.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":32250.41,"maximum":58371.79,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58371.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47398.37},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":40443.11},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32915.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":34062.32},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40237.94},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32428.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45400.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45252.3},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32428.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34050.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55128.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47435.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32980.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32428.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32428.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47402.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32428.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32250.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":32428.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32428.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":40134.1,"maximum":72640.91,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72640.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":63845.84},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":54477.07},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40961.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":45882.12},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54200.7},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40356.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56498.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60955.06},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40356.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42373.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68605.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63895.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41042.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40356.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40356.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63851.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":40356.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40134.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":40356.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40356.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":26366.53,"maximum":47722.23,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47722.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38770.93},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":33081.66},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26910.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":27862.31},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32913.84},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26512.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37117.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37015.48},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26512.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27837.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45071.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38801.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26963.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26512.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26512.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38774.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26512.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26366.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":26512.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26512.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":7196.94,"10th_percentile":7196.94,"90th_percentile":7196.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24732.4,"10th_percentile":24732.4,"90th_percentile":24732.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":25492.44,"maximum":46140.16,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46140.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38357.41},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":32728.82},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26017.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":27565.13},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32562.78},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25633.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35886.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36620.68},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25633.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26915.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43576.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38387.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26069.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25633.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25633.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38360.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25633.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25492.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":25633.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25633.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12444.03,"maximum":22770.45,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22770.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17316.1},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14775.13},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12840.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12444.03},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14700.17},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12650.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17710.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16532.07},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12650.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13282.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21505.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17329.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12865.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12650.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12650.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17317.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12650.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12580.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12650.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12650.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12459.98,"10th_percentile":12459.98,"90th_percentile":12459.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14265.24,"maximum":25819.43,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25819.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20570.02},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17551.56},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14559.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14782.42},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17462.52},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14344.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20081.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19638.66},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14344.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15061.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24385.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20586.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14344.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14344.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20571.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14344.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14265.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14344.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14344.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":20297.42,"10th_percentile":20297.42,"90th_percentile":20297.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":16681.41,"10th_percentile":16681.41,"90th_percentile":16681.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":11090.59,"10th_percentile":11090.59,"90th_percentile":11090.59,"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":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":27926.13,"10th_percentile":27926.13,"90th_percentile":27926.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14183.3,"10th_percentile":14183.3,"90th_percentile":14183.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13589.37,"maximum":24596.14,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24596.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20083.72},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17136.63},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13869.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14432.95},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17049.69},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13664.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19130.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19174.38},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13664.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14347.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23229.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20099.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13896.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13664.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13664.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20085.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13664.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13589.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13664.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13664.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13645.47,"10th_percentile":13645.47,"90th_percentile":13645.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":15869.36,"10th_percentile":15869.36,"90th_percentile":15869.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13369.92,"10th_percentile":9240.56,"90th_percentile":13527.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13602.6,"10th_percentile":13602.6,"90th_percentile":13602.6,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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","minimum":8282.74,"maximum":11534.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11525.59},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9834.32},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8282.74},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9784.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11003.74},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11534.57},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11526.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":13829.47,"10th_percentile":13829.47,"90th_percentile":13829.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10887.59,"maximum":19802.25,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19802.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15150.29},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12927.13},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11166.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10887.59},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12861.55},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11001.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15401.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14464.32},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11001.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11551.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18702.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15162.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11188.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11001.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11001.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15151.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11001.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10940.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11001.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11001.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":27155.05,"maximum":49149.41,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49149.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42142.67},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":35958.63},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27714.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":30285.37},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35776.21},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27305.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38227.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40234.56},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27305.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28670.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46418.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42175.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27769.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27305.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27305.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42146.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27305.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27155.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":27305.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27305.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9610.95,"maximum":17395.38,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17395.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13392.23},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11427.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9809.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9624.18},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11369.08},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9664.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13529.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12785.86},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9664.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10147.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16428.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13402.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9664.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9664.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13393.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9664.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9610.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9664.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9664.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":9896.1,"10th_percentile":9896.1,"90th_percentile":9896.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":11364.43,"10th_percentile":11364.43,"90th_percentile":11364.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5630.57,"maximum":12958.94,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12958.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7835.04},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6685.32},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7307.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5630.57},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6651.41},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7199.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10079.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7480.29},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7199.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12239.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7841.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7321.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7199.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7199.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7835.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7199.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7159.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7199.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7199.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":3323.7,"10th_percentile":3323.7,"90th_percentile":3323.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10450.66,"maximum":18915.23,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18915.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15858.37},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13531.3},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10666.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11396.44},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13462.66},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10508.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14711.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15140.34},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10508.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11033.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17864.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15870.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10508.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10508.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15859.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10508.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10450.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10508.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10508.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10332.25,"maximum":19389.19,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19389.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14377.53},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12267.76},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10933.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10332.25},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12205.53},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15080.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13726.55},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10771.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11310.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18312.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14388.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10954.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14378.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10771.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10712.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10771.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7749.81,"maximum":14689.3,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14689.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10784.01},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9201.56},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8283.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7749.81},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9154.88},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11425.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10295.74},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8160.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8568.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13873.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10792.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8299.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10784.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8160.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8115.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8160.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9554.35,"10th_percentile":9554.35,"90th_percentile":9554.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":10241.35,"10th_percentile":10241.35,"90th_percentile":10241.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":143.03,"10th_percentile":143.03,"90th_percentile":143.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":23183.22,"maximum":41960.57,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41960.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35443.09},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":30242.15},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23661.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25470.79},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30088.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23311.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32636.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33838.32},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23311.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24477.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39629.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35470.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23707.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23311.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23311.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35446.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23311.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23183.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":23311.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23311.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6925.75,"maximum":12535.29,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12535.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9673.96},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8254.4},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7068.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6952.09},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8212.53},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9749.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9235.95},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6964.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7312.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11838.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9681.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7082.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9674.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6964.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6925.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6964.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9324.51,"maximum":17220.62,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17220.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12975.24},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11071.24},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9710.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9324.51},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11015.08},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13393.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12387.75},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9567.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10045.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16263.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12985.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9729.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12976.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9567.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9514.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9567.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":11214.4,"10th_percentile":11214.4,"90th_percentile":11214.4,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8760.44,"10th_percentile":7577.91,"90th_percentile":9049.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6841.02,"10th_percentile":6841.02,"90th_percentile":6841.02,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8915.79,"10th_percentile":8915.79,"90th_percentile":8915.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":8880.09,"10th_percentile":7087.75,"90th_percentile":9035.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5814.02,"maximum":12037.5,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12037.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8090.32},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6903.14},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6787.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5814.02},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6868.12},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6687.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9362.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7724.01},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6687.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7021.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11368.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8096.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6801.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6687.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6687.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8091.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6687.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6650.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6687.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6687.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7519.05,"maximum":15014.99,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15014.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10462.9},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8927.56},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8466.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7519.05},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8882.27},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11678.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9989.16},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8341.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14180.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10471.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8483.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10463.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8341.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8341.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7471.54,"10th_percentile":6300.99,"90th_percentile":8160.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":57575.81,"maximum":104209.61,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104209.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":89370.09},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":76255.87},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58762.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":64224.84},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75869.02},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57894.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81051.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85323.64},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57894.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60788.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98420.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89439.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58878.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57894.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57894.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89377.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":57894.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57575.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":57894.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57894.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":41369.55,"maximum":74877.01,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74877.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61450.16},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":52432.93},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42222.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":44160.49},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52166.94},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41598.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58237.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58667.86},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41598.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43678.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70717.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61498.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42305.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41598.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41598.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61455.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":41598.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41369.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":41598.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41598.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14633.16,"maximum":26485.36,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26485.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20846.09},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17787.12},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14934.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14980.81},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17696.89},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14714.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20599.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19902.23},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14714.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15449.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25013.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20862.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14964.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14714.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14714.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20847.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14714.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14633.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14714.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14714.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14151.9,"10th_percentile":14151.9,"90th_percentile":14151.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6983.42,"10th_percentile":6983.42,"90th_percentile":6983.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13831.48,"maximum":25034.35,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25034.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19562.77},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16692.12},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14116.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14058.57},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16607.44},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19471.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18677.02},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13907.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14603.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23643.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19578.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14144.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19564.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13907.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13831.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13907.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":25847.19,"maximum":46782.25,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46782.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40369.59},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":34445.73},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26379.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29011.16},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34270.99},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25990.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36386.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38541.76},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25990.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27289.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44183.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40401.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26431.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25990.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25990.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40373.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25990.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25847.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":25990.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25990.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":16022.04,"10th_percentile":16022.04,"90th_percentile":16022.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24175.27,"10th_percentile":24175.27,"90th_percentile":24175.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":20086.2,"maximum":36355.12,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36355.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28900.6},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":24659.71},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20500.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20769.1},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24534.61},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20197.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28276.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27592.06},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20197.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21207.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34335.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28923.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20540.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20197.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20197.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28903.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20197.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20086.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":20197.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20197.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":37666.41,"10th_percentile":37666.41,"90th_percentile":37666.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13145.37,"maximum":23792.53,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23792.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18960.97},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16178.62},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13416.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13626.09},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16096.55},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13218.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18505.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18102.46},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13218.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13878.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22470.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18975.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13442.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13218.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13218.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18962.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13218.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13145.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13218.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13218.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":17188.67,"10th_percentile":17188.67,"90th_percentile":17188.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":15810.01,"10th_percentile":15810.01,"90th_percentile":15810.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11529.27,"10th_percentile":11467.07,"90th_percentile":12685.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":11676.65,"10th_percentile":11676.65,"90th_percentile":11676.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":9168.42,"10th_percentile":9168.42,"90th_percentile":9168.42,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":14832.4,"10th_percentile":14832.4,"90th_percentile":14832.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":10369.84,"10th_percentile":6840.48,"90th_percentile":12717.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23285.59,"10th_percentile":23285.59,"90th_percentile":23285.59,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":21206.81,"maximum":38383.36,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38383.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31549.25},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":26919.69},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21643.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22672.52},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26783.13},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21324.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29853.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30120.78},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21324.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22390.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36250.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31573.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21686.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21324.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21324.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31551.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21324.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21206.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":21324.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21324.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12836.69,"maximum":23233.82,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23233.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18924.0},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16147.08},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13101.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13599.53},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16065.17},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12907.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18070.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18067.17},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12907.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13553.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21943.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18938.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13127.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12907.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12907.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18925.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12907.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12836.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12907.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12907.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9752.01,"maximum":18310.19,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18310.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13570.11},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11578.83},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10324.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9752.01},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11520.09},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10172.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14241.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12955.69},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10172.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10680.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17292.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13580.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10172.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10172.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13571.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10172.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10116.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10172.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10172.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":7071.93,"10th_percentile":7071.93,"90th_percentile":7071.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7232.66,"maximum":14094.86,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14094.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10064.39},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8587.53},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7947.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7232.66},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8543.97},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10962.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9608.7},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7830.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13311.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10072.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10065.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7830.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7787.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7830.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":2084.21,"10th_percentile":2084.21,"90th_percentile":2084.21,"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":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9441.41,"10th_percentile":9441.41,"90th_percentile":10276.89,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5909.34,"10th_percentile":5909.34,"90th_percentile":6833.1,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":772.0,"10th_percentile":772.0,"90th_percentile":6801.94,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":8434.81,"10th_percentile":8434.81,"90th_percentile":8434.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2335.3,"10th_percentile":2335.3,"90th_percentile":2335.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6675.22,"10th_percentile":6675.22,"90th_percentile":6675.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":21313.6,"maximum":38576.65,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38576.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32882.23},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":28057.08},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21752.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":23630.46},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27914.74},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21431.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30004.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31393.41},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21431.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22503.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36433.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32907.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21795.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21431.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21431.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32885.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21431.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21313.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":21431.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21431.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21080.47,"10th_percentile":21080.47,"90th_percentile":21080.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":29658.53,"10th_percentile":29658.53,"90th_percentile":29658.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":20652.74,"10th_percentile":20652.74,"90th_percentile":20652.74,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":32482.59,"10th_percentile":32482.59,"90th_percentile":32482.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20650.53,"10th_percentile":19654.1,"90th_percentile":21126.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":35033.62,"maximum":63409.27,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63409.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53038.73},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":45255.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35755.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":38115.7},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45026.21},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35227.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49318.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50637.27},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35227.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36988.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59886.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53080.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35826.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35227.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35227.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53043.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":35227.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35033.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":35227.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35227.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":19408.0,"10th_percentile":19408.0,"90th_percentile":19408.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":41339.28,"10th_percentile":41339.28,"90th_percentile":41339.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":36271.78,"10th_percentile":36271.78,"90th_percentile":36271.78,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":52124.57,"10th_percentile":52124.57,"90th_percentile":52124.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33546.62,"10th_percentile":24701.83,"90th_percentile":112939.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33671.34,"10th_percentile":33671.34,"90th_percentile":33671.34,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12639.93,"maximum":22877.69,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22877.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17730.79},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15128.96},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12900.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12742.04},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15052.21},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17793.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16927.98},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12709.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13345.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21606.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17744.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12925.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17732.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12709.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12639.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12709.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12490.51,"maximum":22738.68,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22738.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17380.79},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14830.32},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12822.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12490.51},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14755.09},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12632.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17685.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16593.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12632.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13264.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21475.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17394.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12847.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12632.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12632.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17382.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12632.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12563.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12632.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12632.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10682.85,"10th_percentile":10682.85,"90th_percentile":10682.85,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11700.94,"10th_percentile":11700.94,"90th_percentile":11700.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13056.12,"maximum":23630.99,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23630.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19289.01},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16458.53},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13325.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13861.84},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16375.04},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13128.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18379.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18415.66},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13128.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13784.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22318.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19304.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13128.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13128.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19290.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13128.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13056.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13128.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13128.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11572.54,"10th_percentile":11572.54,"90th_percentile":11572.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7328.95,"maximum":14792.56,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14792.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10198.38},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8701.86},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8341.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7328.95},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8657.72},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8218.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11505.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9736.62},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8218.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13970.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10206.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8357.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8218.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8218.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10199.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8218.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8172.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8218.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8218.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7218.55,"maximum":13872.44,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13872.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10044.75},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8570.78},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7822.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7218.55},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8527.3},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10789.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9589.95},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7706.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13101.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10052.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7837.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10045.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7706.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7706.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":9138.28,"10th_percentile":9138.28,"90th_percentile":9138.28,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6477.27,"maximum":12876.86,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12876.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9013.25},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7690.64},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7261.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6477.27},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7651.62},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7153.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10015.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8605.15},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7153.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7511.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12161.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9020.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7153.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7153.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9014.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7153.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7114.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7153.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7153.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"13","median_amount":7217.38,"10th_percentile":5696.41,"90th_percentile":9005.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8133.17,"10th_percentile":8133.17,"90th_percentile":8133.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":576.12,"10th_percentile":576.12,"90th_percentile":5444.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":5657.95,"10th_percentile":5657.95,"90th_percentile":6477.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9236.19,"10th_percentile":6957.21,"90th_percentile":12075.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3794.04,"10th_percentile":3794.04,"90th_percentile":3794.04,"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 Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":8564.12,"10th_percentile":8564.12,"90th_percentile":8564.12,"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 Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6669.86,"10th_percentile":6669.86,"90th_percentile":6669.86,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":9014.03,"10th_percentile":8001.62,"90th_percentile":9014.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9989.54,"10th_percentile":7479.82,"90th_percentile":11375.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":6464.83,"10th_percentile":655.37,"90th_percentile":6609.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":41426.59,"maximum":74980.26,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74980.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":62703.45},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":53502.31},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42280.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":45061.15},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53230.89},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41655.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58317.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59864.4},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41655.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43738.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70814.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62752.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42363.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41655.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41655.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62708.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":41655.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41426.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":41655.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41655.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13557.91,"maximum":24539.2,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24539.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19202.38},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16384.61},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13837.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13799.58},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16301.49},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13632.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19086.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18332.95},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13632.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14314.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23175.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19217.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13632.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13632.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19204.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13632.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13557.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13632.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13632.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13592.89,"maximum":25558.61,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25558.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18914.76},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16139.2},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14412.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13592.89},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16057.33},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14199.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19878.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18058.35},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14199.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14909.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24138.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18929.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14440.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14199.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14199.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18916.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14199.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14121.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14199.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14199.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":67313.76,"maximum":121834.85,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121834.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":96335.34},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":82199.04},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68701.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":69230.34},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81782.04},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67686.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94760.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91973.52},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67686.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71070.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115066.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96410.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68836.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67686.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67686.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96343.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":67686.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67313.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":67686.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67686.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":3500.0,"10th_percentile":3500.0,"90th_percentile":3500.0},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13336.27,"maximum":24138.05,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24138.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19218.55},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16398.41},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13611.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13811.2},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16315.22},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13410.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18774.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18348.39},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13410.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14080.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22797.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19233.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13638.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13410.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13410.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19220.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13410.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13336.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13410.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13410.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10436.96,"10th_percentile":10436.96,"90th_percentile":10436.96,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":19205.9,"10th_percentile":19205.9,"90th_percentile":19205.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":17890.29,"10th_percentile":17890.29,"90th_percentile":17890.29,"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":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12852.51,"10th_percentile":12852.51,"90th_percentile":12852.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6617.56,"maximum":13508.37,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13508.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9208.46},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7857.2},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7617.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6617.56},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7817.34},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7504.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10506.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8791.52},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7504.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7879.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12757.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9215.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7632.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7504.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7504.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9209.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7504.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7463.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7504.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7504.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":3422.94,"10th_percentile":3422.94,"90th_percentile":3422.94,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":5344.91,"10th_percentile":5344.91,"90th_percentile":5344.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10558.5,"10th_percentile":10558.5,"90th_percentile":10558.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":5942.81,"10th_percentile":5942.81,"90th_percentile":5942.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":725.6,"10th_percentile":725.6,"90th_percentile":725.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6728.65,"10th_percentile":6728.65,"90th_percentile":6728.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":41810.62,"maximum":75675.33,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75675.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":70885.02},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":60483.32},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42672.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":50940.75},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60176.48},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42041.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58858.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67675.53},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42041.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44143.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71471.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70940.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42756.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42041.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42041.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70891.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":42041.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41810.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":42041.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42041.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":23598.69,"maximum":42712.56,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42712.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37754.44},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":32214.34},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24085.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":27131.82},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32050.91},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33220.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36045.02},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23729.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24915.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40339.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37783.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24132.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37757.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23729.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":23729.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14243.46,"10th_percentile":14243.46,"90th_percentile":14243.46,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":41711.72,"10th_percentile":41711.72,"90th_percentile":41711.72,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":26681.06,"maximum":48291.52,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48291.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39721.58},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":33892.81},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27231.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":28545.48},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33720.87},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26828.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37560.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37923.09},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26828.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28170.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45608.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39752.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27284.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26828.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26828.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39725.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26828.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26681.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":26828.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26828.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16707.58,"maximum":30239.96,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30239.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24496.21},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":20901.62},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17051.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17603.93},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20795.58},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16799.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23519.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23387.08},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16799.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17639.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28559.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24515.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17085.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16799.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16799.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24498.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16799.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16707.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16799.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16799.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":24963.01,"10th_percentile":24963.01,"90th_percentile":24963.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15940.96,"10th_percentile":15940.96,"90th_percentile":15940.96,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14606.83,"maximum":26437.7,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26437.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22788.97},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19444.9},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14907.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16377.04},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19346.26},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14687.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20562.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21757.14},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14687.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15421.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24968.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22806.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14937.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14687.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14687.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22790.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14687.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14606.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14687.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14687.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14573.24,"maximum":27302.2,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27302.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20278.94},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17303.19},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15395.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14573.24},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17215.41},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15167.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21235.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19360.76},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15167.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15926.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25785.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20294.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15425.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15167.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15167.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20280.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15167.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15084.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15167.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15167.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14932.6,"10th_percentile":14932.6,"90th_percentile":14932.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13345.52,"maximum":24471.68,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24471.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18570.54},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15845.49},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13799.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13345.52},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15765.11},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13595.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19033.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17729.72},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13595.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14275.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23112.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18585.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13826.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13595.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13595.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18572.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13595.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13520.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13595.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13595.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":340.0,"10th_percentile":340.0,"90th_percentile":340.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11896.16,"maximum":22333.57,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22333.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16553.74},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14124.63},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12593.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11896.16},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14052.98},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12407.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17370.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15804.23},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12407.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13027.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21092.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16566.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12618.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12407.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12407.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16555.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12407.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12339.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12407.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12407.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5574.12,"maximum":12091.79,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12091.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7756.5},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6618.3},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6818.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5574.12},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6584.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6717.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9404.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7405.3},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6717.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11420.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7762.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6717.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6717.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7757.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6717.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6717.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6717.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9610.07,"maximum":17825.65,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17825.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13372.59},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11410.29},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10051.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9610.07},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11352.41},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9903.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13864.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12767.12},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9903.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16835.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13383.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9903.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9903.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13373.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9903.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9848.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9903.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9903.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6928.01,"maximum":13545.43,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13545.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9640.46},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8225.82},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7638.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6928.01},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8184.09},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10535.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9203.97},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7525.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12792.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9647.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7653.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9641.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7525.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7525.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7456.18,"10th_percentile":7456.18,"90th_percentile":7456.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11833.85,"maximum":21418.74,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21418.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16907.2},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14426.23},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12077.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12150.17},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14353.04},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11899.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16659.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16141.68},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11899.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12494.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20228.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16920.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12101.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11899.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11899.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16908.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11899.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11833.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11899.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11899.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9898.39,"10th_percentile":9898.39,"90th_percentile":10000.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":49332.97,"maximum":89290.44,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89290.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":71128.75},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":60691.28},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50349.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":51115.9},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60383.39},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49605.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69448.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67908.22},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49605.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52086.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71184.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50449.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49605.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49605.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71134.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":49605.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49332.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":49605.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49605.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62837.94,"10th_percentile":62837.94,"90th_percentile":62837.94,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11945.97,"maximum":21661.02,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21661.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16623.04},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14183.77},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12214.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11945.97},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14111.81},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16847.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15870.39},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12033.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12635.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20457.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16636.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12238.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16624.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12033.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11967.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12033.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16924.09,"maximum":30631.84,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30631.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24430.37},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":20845.44},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17272.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17556.62},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20739.69},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17017.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23824.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23324.22},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17017.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17868.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28930.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24449.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17306.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17017.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17017.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24432.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17017.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16924.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17017.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17017.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7312.35,"maximum":14085.59,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14085.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10175.28},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8682.15},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7942.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7312.35},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8638.11},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10955.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9714.57},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7825.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8216.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13303.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10183.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7958.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10176.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7825.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7782.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7825.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":281.6,"10th_percentile":281.6,"90th_percentile":281.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9962.35,"10th_percentile":9544.35,"90th_percentile":10374.12,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":6330.34,"10th_percentile":6330.34,"90th_percentile":6330.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7650.22,"10th_percentile":7650.22,"90th_percentile":7650.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7229.34,"10th_percentile":7229.34,"90th_percentile":7229.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":7568.17,"10th_percentile":7568.17,"90th_percentile":7568.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10255.82,"10th_percentile":10255.82,"90th_percentile":10255.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":7282.09,"10th_percentile":7282.09,"90th_percentile":7282.09,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1400.0,"10th_percentile":1400.0,"90th_percentile":1400.0},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":7213.27,"10th_percentile":7213.27,"90th_percentile":8479.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4797.96,"10th_percentile":4797.96,"90th_percentile":4797.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":7186.48,"10th_percentile":293.25,"90th_percentile":7419.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7309.45,"10th_percentile":7309.45,"90th_percentile":7309.45,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15092.52,"maximum":27316.78,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27316.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22318.84},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19043.76},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15403.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16039.19},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18947.15},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15175.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21246.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21308.3},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15175.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15934.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25799.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22336.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15175.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15175.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22320.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15175.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15092.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15175.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15175.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":17493.0,"10th_percentile":17493.0,"90th_percentile":17493.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":20852.79,"10th_percentile":20064.39,"90th_percentile":22787.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14732.2,"10th_percentile":14732.2,"90th_percentile":14732.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":19144.73,"10th_percentile":19144.73,"90th_percentile":22603.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14786.59,"10th_percentile":10660.36,"90th_percentile":15023.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":23502.86,"maximum":42539.11,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42539.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33115.56},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":28256.17},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23987.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":23798.14},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28112.82},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23632.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33085.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31616.17},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23632.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24814.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40175.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33141.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24034.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23632.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23632.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33118.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23632.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23502.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":23632.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23632.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21159.64,"10th_percentile":21159.64,"90th_percentile":21159.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5201.41,"maximum":10779.79,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10779.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7237.86},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6175.77},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6078.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5201.41},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6144.44},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5988.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8384.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6910.14},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5988.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6288.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10180.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7243.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6090.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5988.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5988.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7238.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5988.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5955.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":5988.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5988.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":6978.76,"10th_percentile":6978.76,"90th_percentile":6978.76,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":5156.58,"10th_percentile":5156.58,"90th_percentile":5201.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6710.06,"10th_percentile":6710.06,"90th_percentile":6710.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6667.48,"10th_percentile":6667.48,"90th_percentile":6667.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":5652.24,"10th_percentile":5652.24,"90th_percentile":5652.24,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":7002.13,"10th_percentile":7002.13,"90th_percentile":7002.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3710.67,"10th_percentile":3710.67,"90th_percentile":3710.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5299.0,"10th_percentile":5299.0,"90th_percentile":5299.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":28518.49,"maximum":51617.18,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51617.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40107.38},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":34222.0},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29106.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":28822.73},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34048.39},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28676.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38291.42},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28676.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30110.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48749.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40138.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29163.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28676.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28676.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40110.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28676.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28518.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":28676.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28676.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":19997.69,"maximum":36194.92,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36194.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29850.09},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":25469.88},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20409.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21451.44},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25340.67},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20108.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28151.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28498.56},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20108.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21113.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34184.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29873.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20450.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20108.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20108.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29852.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20108.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19997.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":20108.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20108.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10472.13,"10th_percentile":10472.13,"90th_percentile":10472.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8530.94,"maximum":17200.76,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17200.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11870.96},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10129.01},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9699.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8530.94},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10077.63},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9555.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13378.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11333.48},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9555.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10033.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16245.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11880.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9718.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9555.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9555.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11871.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9555.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9503.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9555.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9555.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12992.73,"maximum":24286.34,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24286.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18079.63},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15426.61},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13694.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12992.73},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15348.35},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13492.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18889.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17261.03},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13492.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14167.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22937.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18093.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13721.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13492.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13492.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18081.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13492.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13418.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13492.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13492.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6662.38,"maximum":13272.71,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13272.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9270.83},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7910.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7484.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6662.38},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7870.3},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7373.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10323.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8851.07},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7373.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12535.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9278.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7499.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7373.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7373.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9271.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7373.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7333.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7373.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7373.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":2286.26,"10th_percentile":2286.26,"90th_percentile":2286.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7509.78,"10th_percentile":6871.13,"90th_percentile":9647.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7978.43,"10th_percentile":7978.43,"90th_percentile":7978.43,"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":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5824.02,"10th_percentile":5141.94,"90th_percentile":6770.39,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":11926.64,"10th_percentile":9986.2,"90th_percentile":16491.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6755.13,"10th_percentile":4715.29,"90th_percentile":6806.89,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":9271.64,"10th_percentile":8329.68,"90th_percentile":9271.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3234.07,"10th_percentile":3234.07,"90th_percentile":13313.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"30","median_amount":5754.76,"10th_percentile":167.53,"90th_percentile":7262.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5761.72,"maximum":11689.31,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11689.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8017.55},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6841.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6591.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5761.72},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6806.34},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6494.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9091.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7654.53},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6494.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6818.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11039.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8023.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6604.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6494.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6494.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8018.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6494.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6458.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6494.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6494.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6039.25,"10th_percentile":6039.25,"90th_percentile":6039.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7799.62,"maximum":16554.69,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16554.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10853.32},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9260.7},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9335.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7799.62},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9213.72},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9197.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12875.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10361.91},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9197.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15634.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10861.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9197.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9197.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10854.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9197.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9197.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9197.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9971.55,"maximum":18048.06,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18048.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14590.07},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12449.11},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10177.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10484.99},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12385.96},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10026.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14037.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13929.47},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10026.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10528.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17045.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14601.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10026.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10026.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14591.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10026.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10026.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10026.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":27558.08,"maximum":49878.88,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49878.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45479.75},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":38806.03},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28126.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":32683.53},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38609.16},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27710.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38794.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43420.54},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27710.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29096.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47107.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45515.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28181.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27710.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27710.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45483.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27710.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27558.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":27710.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27710.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16219.32,"maximum":29683.93,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29683.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22569.5},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19257.64},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16738.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16219.32},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19159.94},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16491.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23087.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21547.61},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16491.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17315.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28034.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22587.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16771.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16491.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16491.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22571.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16491.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16400.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16491.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16491.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6966.17,"10th_percentile":6966.17,"90th_percentile":6966.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9214.94,"maximum":16957.15,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16957.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12822.77},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10941.15},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9561.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9214.94},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10885.64},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9420.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13188.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12242.18},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9420.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9891.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16015.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12832.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9580.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9420.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9420.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12823.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9420.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9368.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9420.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9420.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":9242.51,"10th_percentile":9242.51,"90th_percentile":9242.51,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11534.24,"maximum":24927.12,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24927.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16050.11},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13694.91},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14056.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11534.24},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13625.44},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13848.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19387.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15323.41},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13848.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14540.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23542.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16062.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14083.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13848.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13848.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16051.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13848.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13772.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13848.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13848.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8814.0,"maximum":17341.09,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17341.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12264.85},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10465.1},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9778.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8814.0},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10412.01},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9633.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13487.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11709.53},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9633.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10115.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16377.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12274.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9797.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9633.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9633.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12265.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9633.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9580.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9633.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9633.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":4323.64,"10th_percentile":4323.64,"90th_percentile":4323.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8211.18,"10th_percentile":7111.13,"90th_percentile":9208.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":7273.35,"10th_percentile":7273.35,"90th_percentile":7273.35},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":7720.35,"10th_percentile":7720.35,"90th_percentile":7720.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11341.4,"10th_percentile":11341.4,"90th_percentile":11341.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":8996.0,"10th_percentile":7206.2,"90th_percentile":8996.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6427.68,"10th_percentile":4797.96,"90th_percentile":7196.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":1658.54,"maximum":5200.81,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5200.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":2307.89},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":1969.23},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2932.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":1658.54},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1959.24},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2889.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4045.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2203.39},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2889.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4911.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2309.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2938.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2889.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2889.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2308.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":2889.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2873.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":2889.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2889.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":726.0,"10th_percentile":705.0,"90th_percentile":1374.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"144","median_amount":1023.0,"10th_percentile":864.0,"90th_percentile":2046.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"31","median_amount":1280.0,"10th_percentile":660.8,"90th_percentile":2046.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"11","median_amount":811.2,"10th_percentile":343.5,"90th_percentile":1374.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4156.56,"10th_percentile":3397.25,"90th_percentile":6709.73},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"27","median_amount":2414.25,"10th_percentile":2414.25,"90th_percentile":4828.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3239.6,"10th_percentile":2573.45,"90th_percentile":7720.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":663.0,"10th_percentile":663.0,"90th_percentile":663.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":1345.0,"10th_percentile":1345.0,"90th_percentile":2663.51,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":2463.44,"10th_percentile":2463.44,"90th_percentile":2463.44,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":3573.68,"10th_percentile":3573.68,"90th_percentile":3573.68},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"93","median_amount":1530.0,"10th_percentile":1224.0,"90th_percentile":3060.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"81","median_amount":3019.99,"10th_percentile":2398.98,"90th_percentile":4797.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14774.95,"maximum":27165.85,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27165.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20559.62},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17542.69},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15318.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14774.95},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17453.7},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15092.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21129.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19628.74},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15092.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15846.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25656.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20575.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15348.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15092.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15092.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20561.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15092.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15009.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15092.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15092.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11677.85,"maximum":21147.34,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21147.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16249.95},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13865.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11924.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11677.85},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13795.08},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11748.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16447.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15514.19},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11748.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19972.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16262.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11948.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11748.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11748.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16251.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11748.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11683.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11748.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11748.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10164.66,"10th_percentile":10164.66,"90th_percentile":10164.66,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10151.88,"10th_percentile":10151.88,"90th_percentile":10151.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9902.97,"10th_percentile":9094.4,"90th_percentile":11657.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6777.77,"maximum":13939.96,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13939.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9431.39},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8047.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7860.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6777.77},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8006.6},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7744.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10842.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9004.36},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7744.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8131.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13165.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9438.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7876.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7744.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7744.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9432.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7744.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7744.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7744.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18317.54,"maximum":33153.91,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33153.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27256.89},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":23257.2},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18695.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19587.87},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23139.22},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18418.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25786.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26022.77},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18418.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19339.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31312.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27278.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18731.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18418.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18418.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27259.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18418.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18317.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18418.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18418.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16668.81,"maximum":30169.8,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30169.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24670.63},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21050.44},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17012.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17729.28},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20943.65},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16761.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23465.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23553.6},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16761.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17599.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28493.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24689.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17045.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16761.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16761.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24672.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16761.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16668.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16761.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16761.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":23245.56,"10th_percentile":23245.56,"90th_percentile":23245.56,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":18638.02,"10th_percentile":18638.02,"90th_percentile":18638.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4743.17,"10th_percentile":4743.17,"90th_percentile":4743.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15714.62,"maximum":28965.04,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28965.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21867.2},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18658.39},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16333.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15714.62},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18563.74},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16091.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22528.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20877.11},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16091.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16896.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27355.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21884.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16365.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16091.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16091.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21869.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16091.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16003.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16091.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16091.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":37535.95,"maximum":67938.37,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67938.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":57772.33},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":49294.78},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38309.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":41517.45},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49044.71},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37743.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52840.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55156.54},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37743.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39630.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64164.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57817.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38385.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37743.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37743.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57777.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":37743.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37535.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":37743.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37743.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":9996.0,"10th_percentile":9996.0,"90th_percentile":9996.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":56941.5,"10th_percentile":43284.49,"90th_percentile":143779.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35849.43,"10th_percentile":35849.43,"90th_percentile":36423.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":42126.0,"10th_percentile":42126.0,"90th_percentile":42126.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":31161.93,"10th_percentile":31161.93,"90th_percentile":31161.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":13228.31,"10th_percentile":13228.31,"90th_percentile":13228.31,"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":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":50330.55,"10th_percentile":50330.55,"90th_percentile":50330.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":35632.68,"10th_percentile":35632.68,"90th_percentile":35632.68,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":4400.0,"10th_percentile":4400.0,"90th_percentile":4400.0},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35166.15,"10th_percentile":35166.15,"90th_percentile":35166.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":57558.0,"10th_percentile":57558.0,"90th_percentile":57558.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8845.18,"10th_percentile":8845.18,"90th_percentile":8845.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":34894.24,"10th_percentile":26611.92,"90th_percentile":37341.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7453.47,"maximum":14308.0,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14308.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10371.64},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8849.7},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8068.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7453.47},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8804.81},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7948.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11128.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9902.04},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7948.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8346.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13513.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10379.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8084.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7948.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7948.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10372.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7948.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7948.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7948.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7872.35,"10th_percentile":7872.35,"90th_percentile":7872.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8558.33,"maximum":16103.23,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16103.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11909.08},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10161.54},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9080.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8558.33},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10109.99},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8946.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12524.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11369.87},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8946.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9393.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15208.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11918.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8946.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8946.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11910.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8946.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8897.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8946.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8946.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":4706.44,"10th_percentile":4706.44,"90th_percentile":4706.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":11540.14,"10th_percentile":9733.4,"90th_percentile":12286.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8407.86,"10th_percentile":8399.12,"90th_percentile":8477.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8558.33,"10th_percentile":8558.33,"90th_percentile":8558.33,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":14013.24,"10th_percentile":8911.54,"90th_percentile":15415.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":11365.38,"10th_percentile":11365.38,"90th_percentile":11365.38,"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 Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":11299.68,"10th_percentile":11299.68,"90th_percentile":11299.68,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":13065.44,"10th_percentile":13065.44,"90th_percentile":13065.44,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":8453.7,"10th_percentile":7152.57,"90th_percentile":22927.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":8931.98,"10th_percentile":8931.98,"90th_percentile":8931.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8861.88,"10th_percentile":8861.88,"90th_percentile":11596.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":7894.45,"10th_percentile":128.33,"90th_percentile":8533.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8443.87,"10th_percentile":8443.87,"90th_percentile":15970.75,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14911.92,"maximum":30030.79,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30030.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20750.22},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17705.32},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16934.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14911.92},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17615.5},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16683.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23357.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19810.7},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16683.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17517.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28362.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20766.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16967.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16683.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16683.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20752.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16683.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16592.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16683.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16683.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3507.74,"10th_percentile":3507.74,"90th_percentile":3507.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9967.17,"maximum":18040.12,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18040.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14080.67},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12014.46},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10172.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10118.92},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11953.51},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10022.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14031.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13443.13},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10022.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17037.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14091.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10192.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10022.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10022.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14081.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10022.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9967.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10022.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10022.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9713.5,"10th_percentile":9713.5,"90th_percentile":9713.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7606.21,"maximum":14278.88,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14278.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10584.18},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9031.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8051.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7606.21},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8985.24},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7932.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11105.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10104.96},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7932.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8329.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13485.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10592.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8067.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7932.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7932.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10585.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7932.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7889.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7932.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7932.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":27166.0,"10th_percentile":27166.0,"90th_percentile":27166.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":252.53,"10th_percentile":252.53,"90th_percentile":7481.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14022.05,"maximum":25716.17,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25716.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19511.95},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16648.76},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14501.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14022.05},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16564.3},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14286.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20001.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18628.5},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14286.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15001.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24287.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19527.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14529.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14286.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14286.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19513.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14286.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14208.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14286.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14286.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":3780.9,"10th_percentile":3780.9,"90th_percentile":3780.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":26345.71,"maximum":50593.81,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50593.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36660.56},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":31280.97},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28529.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":26345.71},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31122.28},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28107.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39350.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35000.67},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28107.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29513.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47783.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36689.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28585.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28107.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28107.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36663.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28107.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27953.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":28107.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28107.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":4865.22,"maximum":10865.84,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10865.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":6770.04},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":5776.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6127.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4865.22},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5747.3},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8451.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6463.51},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6036.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6338.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10262.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6775.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6139.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6770.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6036.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6003.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6036.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12453.16,"maximum":22845.92,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22845.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17328.81},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14785.97},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12882.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12453.16},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14710.96},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12692.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17769.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16544.21},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12692.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13326.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21576.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17342.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12907.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12692.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12692.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17330.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12692.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12622.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12692.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12692.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":35730.7,"maximum":64670.96,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64670.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54916.92},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":46858.38},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36467.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":39465.44},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46620.67},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35928.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50299.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52430.42},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35928.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37724.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61078.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54959.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36539.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35928.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35928.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54921.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":35928.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35730.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":35928.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35928.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":51865.62,"10th_percentile":51865.62,"90th_percentile":51865.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":21209.13,"10th_percentile":21209.13,"90th_percentile":21209.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33003.83,"10th_percentile":32900.72,"90th_percentile":35722.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2961.65,"10th_percentile":2961.65,"90th_percentile":2961.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":51290.87,"10th_percentile":51290.87,"90th_percentile":51290.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32923.18,"10th_percentile":24069.35,"90th_percentile":34481.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34819.86,"10th_percentile":34819.86,"90th_percentile":34819.86,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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","minimum":38231.09,"maximum":53203.89,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53199.29},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":45392.79},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":38231.09},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45162.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50790.56},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53203.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":31588.44,"maximum":57173.65,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57173.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45164.41},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":38536.96},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32239.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":32456.91},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38341.46},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31763.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44468.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43119.48},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31763.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33351.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53997.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45199.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32303.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31763.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31763.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45168.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":31763.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31588.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":31763.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31763.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7651.86,"maximum":14723.71,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14723.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10647.71},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9085.26},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8302.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7651.86},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9039.17},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11451.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10165.61},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8179.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13905.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10656.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10648.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8179.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8179.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10647.71,"10th_percentile":10647.71,"90th_percentile":10647.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":8790.83,"10th_percentile":8790.83,"90th_percentile":10408.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7555.98,"10th_percentile":6453.86,"90th_percentile":8100.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13087.36,"maximum":25153.51,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25153.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18211.31},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15538.97},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14183.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13087.36},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15460.14},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19563.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17386.74},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14672.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23756.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18225.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14211.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18212.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13897.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13974.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5847.22,"maximum":10949.24,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10949.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8136.52},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6942.57},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6174.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5847.22},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6907.35},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8516.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7768.12},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6082.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6387.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10340.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8142.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6186.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8137.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6082.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6049.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6082.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6231.56,"maximum":12552.5,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12552.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8671.34},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7398.9},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7078.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6231.56},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7361.36},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6973.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9763.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8278.72},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6973.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7322.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11855.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8678.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7092.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6973.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6973.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8672.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6973.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6935.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6973.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6973.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8134.59,"10th_percentile":8134.59,"90th_percentile":8134.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10226.34,"10th_percentile":10226.34,"90th_percentile":10226.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6368.17,"10th_percentile":6368.17,"90th_percentile":6368.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3187.36,"10th_percentile":3187.36,"90th_percentile":10761.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4103.47,"10th_percentile":252.53,"90th_percentile":6569.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5921.1,"maximum":12087.81,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12087.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8239.33},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7030.28},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6816.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5921.1},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6994.62},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9401.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7866.27},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11416.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8245.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8240.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6678.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6715.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":386.02,"10th_percentile":386.02,"90th_percentile":386.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":1107.0,"10th_percentile":1107.0,"90th_percentile":1107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":940.39,"10th_percentile":247.33,"90th_percentile":1798.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14307.66,"maximum":25896.22,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25896.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20896.91},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17830.49},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14602.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15017.34},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17740.03},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20141.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19950.75},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14386.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15106.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24457.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20913.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14631.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20898.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14386.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14307.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14386.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":20487.67,"10th_percentile":19604.49,"90th_percentile":21405.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12259.36,"10th_percentile":12259.36,"90th_percentile":12259.36,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7311.22,"10th_percentile":7311.22,"90th_percentile":7311.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9948.33,"10th_percentile":9948.33,"90th_percentile":9948.33,"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":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":21221.36,"10th_percentile":21221.36,"90th_percentile":21221.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":13907.08,"10th_percentile":13907.08,"90th_percentile":13910.5,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":20249.42,"10th_percentile":20249.42,"90th_percentile":20799.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13866.27,"10th_percentile":13755.44,"90th_percentile":14242.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15650.74,"10th_percentile":15650.74,"90th_percentile":15650.74,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18946.59,"maximum":34292.47,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34292.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27303.1},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":23296.63},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19337.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19621.07},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23178.44},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19051.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26671.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26066.88},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19051.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20003.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32387.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27324.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19051.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19051.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27305.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19051.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18946.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19051.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19051.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":27150.7,"10th_percentile":27150.7,"90th_percentile":27150.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":23296.63,"10th_percentile":23296.63,"90th_percentile":23296.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":11343.17,"10th_percentile":11343.17,"90th_percentile":11343.17,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18136.94,"10th_percentile":18136.94,"90th_percentile":18136.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":20304.18,"maximum":36749.65,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36749.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31123.01},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":26556.01},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20722.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22366.21},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26421.29},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20416.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28583.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29713.84},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20416.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21437.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34708.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31147.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20763.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20416.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20416.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31125.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20416.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20304.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":20416.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20416.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19951.82,"10th_percentile":19951.82,"90th_percentile":19951.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9151.85,"maximum":18016.29,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18016.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12734.98},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10866.24},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10159.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9151.85},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10811.12},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14012.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12158.37},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10509.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17015.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12744.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10179.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12736.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10009.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9954.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10009.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9882.19,"10th_percentile":9882.19,"90th_percentile":9882.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8447.1,"maximum":15797.41,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15797.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11754.3},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10029.47},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8907.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8447.1},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9978.59},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8776.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12286.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11222.09},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8776.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9215.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14919.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11763.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8925.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8776.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8776.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11755.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8776.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8776.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8776.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14783.11,"maximum":26756.77,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26756.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21000.87},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17919.19},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15087.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15092.05},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17828.29},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14864.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20810.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20050.01},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14864.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15608.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25270.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21017.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15117.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14864.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14864.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21002.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14864.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14783.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14864.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14864.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":11442.68,"10th_percentile":11442.68,"90th_percentile":11442.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14625.74,"10th_percentile":14625.74,"90th_percentile":14625.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12985.91,"maximum":23503.91,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23503.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18766.91},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16013.04},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13253.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13486.63},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15931.81},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13057.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18280.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17917.19},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13057.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13710.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22198.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18781.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13279.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13057.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13057.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18768.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13057.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12985.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13057.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13057.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":16356.33,"10th_percentile":16356.33,"90th_percentile":16356.33,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13110.25,"maximum":23728.97,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23728.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19127.3},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16320.55},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13380.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13745.63},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16237.76},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13182.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18455.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18261.27},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13182.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13841.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22410.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19142.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13406.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13182.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13182.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19128.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13182.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13110.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13182.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13182.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":12982.92,"10th_percentile":12982.92,"90th_percentile":12982.92,"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":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12871.13,"10th_percentile":12871.13,"90th_percentile":13135.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":22625.84,"maximum":40951.75,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40951.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32437.52},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":27677.62},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23092.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":23310.87},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27537.21},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22750.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31851.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30968.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22750.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23888.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38676.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32462.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23137.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22750.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22750.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32440.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22750.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22625.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":22750.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22750.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":27471.04,"maximum":49721.35,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49721.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40470.08},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":34531.48},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28037.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29083.38},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34356.3},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27622.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38672.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38637.7},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27622.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29004.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46959.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40501.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28092.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27622.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27622.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40473.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27622.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27471.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":27622.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27622.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11648.8,"maximum":21083.8,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21083.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16971.88},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14481.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11888.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12196.66},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14407.96},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16398.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16203.44},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11713.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19912.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16985.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11912.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16973.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11713.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11648.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11713.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":43596.12,"maximum":78907.0,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78907.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":63185.13},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":53913.31},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44494.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":45407.3},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53639.8},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43837.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61372.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60324.26},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43837.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46029.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74523.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63234.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44582.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43837.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43837.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63190.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":43837.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43596.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":43837.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43837.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39226.83,"10th_percentile":39226.83,"90th_percentile":39226.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2398.98,"10th_percentile":2398.98,"90th_percentile":2398.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39004.83,"10th_percentile":39004.83,"90th_percentile":39352.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7140.52,"maximum":13692.38,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13692.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9936.17},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8478.13},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7720.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7140.52},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8435.12},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10649.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9486.29},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7606.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12931.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9943.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9937.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7606.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7565.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7606.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9716.7,"10th_percentile":9641.18,"90th_percentile":9936.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7027.83,"10th_percentile":7027.83,"90th_percentile":7027.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8162.05,"10th_percentile":8162.05,"90th_percentile":8162.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":6709.38,"10th_percentile":6709.38,"90th_percentile":6709.38,"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 Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":50285.33,"maximum":91014.17,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91014.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":77440.21},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":66076.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51321.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":55651.56},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65741.39},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50563.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70788.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73933.92},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50563.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53091.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85957.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77500.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51423.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50563.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50563.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77446.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":50563.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50285.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":50563.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50563.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":60450.72,"10th_percentile":60450.72,"90th_percentile":60450.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":20868.87,"maximum":37771.7,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37771.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33077.44},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":28223.64},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21299.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":23770.74},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28080.46},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29377.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31579.78},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20984.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22033.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35673.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33103.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21341.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33080.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20984.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20868.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":20984.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15521.15,"maximum":28092.58,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28092.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21779.41},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18583.49},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15841.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15651.54},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18489.21},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15606.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21849.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20793.29},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15606.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16387.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26531.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21796.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15872.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15606.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15606.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21781.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15606.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15521.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15606.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15606.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":24041.54,"10th_percentile":24041.54,"90th_percentile":25180.4,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13539.81,"10th_percentile":13539.81,"90th_percentile":13539.81,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":14435.5,"10th_percentile":14435.5,"90th_percentile":23059.23,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":23624.88,"10th_percentile":22667.9,"90th_percentile":25276.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":14294.78,"10th_percentile":13536.97,"90th_percentile":15405.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15535.24,"10th_percentile":15535.24,"90th_percentile":15535.24,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":19400.1,"maximum":35113.3,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35113.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27010.86},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":23047.27},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19800.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19411.06},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22930.35},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19507.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27310.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25787.88},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19507.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20482.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33162.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27031.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19839.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19507.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19507.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27013.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19507.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19400.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19507.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19507.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12868.14,"maximum":23290.76,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23290.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18251.74},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15573.47},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13133.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13116.41},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15494.46},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18115.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17425.34},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12939.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13586.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21996.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18265.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13159.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18253.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12939.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12868.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12939.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":12278.24,"10th_percentile":12278.24,"90th_percentile":12278.24,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10250.24,"maximum":18552.47,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18552.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15512.99},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13236.61},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10461.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11148.24},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13169.46},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14429.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14810.6},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10822.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17521.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15525.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10482.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15514.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10250.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10306.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14525.64,"maximum":26290.75,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26290.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20278.94},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17303.19},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14825.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14573.24},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17215.41},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14605.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20448.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19360.76},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14605.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15336.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24830.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20294.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14854.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14605.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14605.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20280.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14605.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14525.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14605.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14605.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12497.16,"maximum":23398.0,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23398.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17390.03},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14838.21},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13193.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12497.16},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14762.93},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12998.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18198.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16602.65},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12998.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22098.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17403.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13219.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12998.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12998.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17391.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12998.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12927.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12998.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12998.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11010.28,"10th_percentile":11010.28,"90th_percentile":11010.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":22406.4,"maximum":40554.58,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40554.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33666.54},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":28726.3},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22868.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24194.09},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28580.57},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22530.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31542.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32142.21},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22530.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23656.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38301.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33692.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22913.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22530.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22530.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33669.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22530.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22406.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":22530.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22530.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20332.6,"10th_percentile":20332.6,"90th_percentile":20332.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21598.84,"10th_percentile":21598.84,"90th_percentile":21598.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15819.59,"maximum":28632.74,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28632.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23364.21},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19935.73},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16145.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16790.43},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19834.6},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15907.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22269.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22306.34},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15907.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16702.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27042.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23382.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16177.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15907.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15907.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23366.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15907.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15819.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15907.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15907.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13791.7,"10th_percentile":13791.7,"90th_percentile":13791.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6194.21,"maximum":13626.2,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13626.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8619.36},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7354.55},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7683.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6194.21},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7317.24},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7570.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10598.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8229.09},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7570.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7948.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12869.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8626.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7570.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7570.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8620.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7570.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7528.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7570.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7570.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11080.45,"maximum":20055.11,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20055.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15553.42},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13271.1},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11308.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11177.3},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13203.78},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11141.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15598.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14849.2},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11141.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11698.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18940.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15565.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11331.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11141.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11141.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15554.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11141.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11141.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11141.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7418.6,"maximum":14411.27,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14411.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10323.13},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8808.31},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8126.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7418.6},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8763.62},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8006.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11208.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9855.72},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8006.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8406.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13610.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10331.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8142.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8006.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8006.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10324.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8006.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7962.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8006.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8006.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9291.85,"10th_percentile":9291.85,"90th_percentile":9291.85,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6680.86,"10th_percentile":6680.86,"90th_percentile":6680.86,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10502.14,"10th_percentile":10502.14,"90th_percentile":10502.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6397.92,"10th_percentile":6397.92,"90th_percentile":6397.92,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5669.68,"10th_percentile":587.93,"90th_percentile":7410.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":26803.95,"maximum":48513.94,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48513.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40020.75},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":34148.08},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27356.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":28760.47},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33974.85},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26952.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37733.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38208.71},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26952.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28299.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45818.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40051.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27410.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26952.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26952.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40024.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26952.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26803.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":26952.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26952.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35953.79,"10th_percentile":35953.79,"90th_percentile":35953.79,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14535.88,"maximum":28062.14,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28062.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20226.96},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17258.84},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15823.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14535.88},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17171.29},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15590.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21826.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19311.13},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15590.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16369.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26503.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20242.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15855.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15590.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15590.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20228.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15590.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15504.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15590.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15590.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8973.38,"maximum":16886.99,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12486.63},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10654.34},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9522.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8973.38},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10600.29},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9381.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13134.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11921.27},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9381.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9850.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15948.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12496.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9541.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9381.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9381.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12487.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9381.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9330.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9381.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9381.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":18060.16,"10th_percentile":18060.16,"90th_percentile":18060.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12179.84,"maximum":22044.96,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22044.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17161.32},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14643.06},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12430.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12332.8},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14568.77},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12247.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17146.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16384.3},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12247.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20820.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17174.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12455.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12247.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12247.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17162.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12247.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12179.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12247.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12247.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11568.39,"10th_percentile":11568.39,"90th_percentile":11568.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10334.75,"maximum":21332.68,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21332.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14381.0},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12270.72},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12029.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10334.75},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12208.47},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16592.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13729.86},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11851.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12444.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20147.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14392.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12052.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14382.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11851.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11786.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11851.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12379.53,"maximum":22406.38,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22406.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17432.77},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14874.68},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12634.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12527.87},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14799.22},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12447.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17427.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16643.46},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12447.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13070.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21161.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17446.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12659.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12447.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12447.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17434.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12447.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12379.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12447.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12447.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11024.56,"maximum":20237.81,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20237.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15340.88},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13089.75},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11411.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11024.56},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13023.35},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15740.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14646.29},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11243.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11805.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19113.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15352.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11434.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15342.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11243.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11181.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11243.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":15427.52,"10th_percentile":15427.52,"90th_percentile":15427.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8936.09,"10th_percentile":190.93,"90th_percentile":10715.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9842.81,"10th_percentile":9842.81,"90th_percentile":9842.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":14867.24,"10th_percentile":14867.24,"90th_percentile":14867.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":12053.24,"10th_percentile":12053.24,"90th_percentile":12053.24,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":9287.02,"10th_percentile":9287.02,"90th_percentile":9287.02,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":8865.43,"10th_percentile":350.53,"90th_percentile":10498.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11193.55,"10th_percentile":11193.55,"90th_percentile":11193.55,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":25034.55,"maximum":45311.4,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45311.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35475.43},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":30269.75},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25550.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25494.03},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30116.19},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25173.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35242.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33869.19},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25173.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26431.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42794.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35503.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25600.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25173.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25173.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35478.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25173.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25034.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":25173.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25173.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11079.71,"maximum":20053.78,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20053.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15477.18},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13206.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11308.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11122.51},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13139.06},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11140.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15597.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14776.42},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11140.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11698.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18939.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15489.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11330.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11140.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11140.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15478.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11140.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11140.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11140.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":14107.95,"10th_percentile":13555.98,"90th_percentile":15613.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":14937.94,"10th_percentile":14937.94,"90th_percentile":14937.94,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":11905.61,"10th_percentile":11905.61,"90th_percentile":11905.61,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":14328.43,"10th_percentile":14328.43,"90th_percentile":14328.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9201.32,"10th_percentile":9201.32,"90th_percentile":9201.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10564.55,"10th_percentile":10564.55,"90th_percentile":10564.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":22770.67,"maximum":41213.88,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41213.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33683.87},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":28741.08},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23240.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24206.55},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28595.28},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22896.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32055.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32158.75},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22896.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24041.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38924.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33710.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23285.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22896.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22896.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33686.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22896.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22770.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":22896.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22896.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12244.94,"maximum":22162.79,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22162.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17349.6},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14803.71},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12497.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12468.1},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14728.61},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17237.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16564.06},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12312.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12928.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20931.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17363.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12521.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17351.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12312.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12244.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12312.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":17348.45,"10th_percentile":15974.59,"90th_percentile":17582.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11060.29,"10th_percentile":9792.55,"90th_percentile":12192.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":12892.27,"10th_percentile":12892.27,"90th_percentile":12892.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":40153.32,"10th_percentile":40153.32,"90th_percentile":40153.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":10048.03,"10th_percentile":5300.39,"90th_percentile":11751.3,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":17349.95,"10th_percentile":17349.95,"90th_percentile":17349.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":19290.93,"10th_percentile":19290.93,"90th_percentile":22934.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":11240.26,"10th_percentile":4625.5,"90th_percentile":12128.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11246.49,"maximum":20355.64,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20355.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16983.44},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14491.28},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11478.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12204.96},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14417.76},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11308.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15832.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16214.47},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11308.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11874.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19224.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16996.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11308.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11308.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16984.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11308.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11308.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11308.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16043.41,"maximum":29037.85,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29037.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22414.72},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19125.57},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16374.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16108.09},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19028.54},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16132.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22585.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21399.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16132.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16938.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27424.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22432.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16406.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16132.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16132.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22416.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16132.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16043.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16132.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16132.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":20965.84,"10th_percentile":20965.84,"90th_percentile":20965.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14767.66,"10th_percentile":14767.66,"90th_percentile":14767.66,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20824.27,"10th_percentile":20824.27,"90th_percentile":20824.27,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":21730.84,"10th_percentile":21730.84,"90th_percentile":21730.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14391.67,"10th_percentile":14391.67,"90th_percentile":14391.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17776.99,"maximum":32175.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32175.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26084.47},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22256.82},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18143.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18745.32},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22143.91},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17875.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25025.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24903.43},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17875.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18769.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30388.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26104.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18179.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17875.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17875.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26086.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17875.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17875.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17875.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6178.43,"maximum":12114.29,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12114.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8597.41},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7335.82},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6831.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6178.43},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7298.61},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6730.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9422.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8208.14},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6730.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7066.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11441.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8604.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6844.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6730.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6730.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8598.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6730.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6730.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6730.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6351.3,"10th_percentile":6351.3,"90th_percentile":6351.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16484.49,"maximum":29836.19,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29836.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23082.36},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19695.24},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16824.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16587.89},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19595.33},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16575.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23205.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22037.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16575.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17404.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28178.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23100.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16857.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16575.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16575.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23084.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16575.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16484.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16575.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16575.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8506.86,"maximum":17615.14,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17615.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11837.46},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10100.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9932.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8506.86},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10049.19},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13700.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11301.49},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9786.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16636.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11846.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9952.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11838.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9786.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9732.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9786.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7926.62,"maximum":15271.81,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15271.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11030.05},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9411.49},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8611.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7926.62},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9363.75},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8484.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11878.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10530.64},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8484.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8908.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14423.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11038.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8484.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8484.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11031.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8484.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8484.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8484.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8746.36,"maximum":15830.51,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15830.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12427.72},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10604.07},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8926.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8931.05},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10550.28},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8794.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12312.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11865.03},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8794.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9234.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14951.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12437.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8944.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8794.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8794.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12428.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8794.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8746.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8794.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8794.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3360.13,"10th_percentile":3360.13,"90th_percentile":3360.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7512.41,"maximum":15249.31,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15249.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10453.66},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8919.68},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8598.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7512.41},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8874.43},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8471.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11860.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9980.34},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8471.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8895.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14402.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10461.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8615.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8471.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8471.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10454.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8471.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8425.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8471.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8471.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":4281.0,"10th_percentile":4281.0,"90th_percentile":4281.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"60","median_amount":8551.62,"10th_percentile":6869.95,"90th_percentile":9208.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"18","median_amount":8094.0,"10th_percentile":7774.32,"90th_percentile":9382.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":6028.11,"10th_percentile":4649.4,"90th_percentile":6895.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":12131.82,"10th_percentile":12131.82,"90th_percentile":12131.82},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6468.76,"10th_percentile":4828.49,"90th_percentile":8608.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6895.08,"10th_percentile":5146.9,"90th_percentile":9176.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":5723.25,"10th_percentile":5723.25,"90th_percentile":5754.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10542.43,"10th_percentile":10542.43,"90th_percentile":10542.43,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":7930.85,"10th_percentile":7792.2,"90th_percentile":8331.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":8257.93,"10th_percentile":8257.93,"90th_percentile":8257.93,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"23","median_amount":8500.37,"10th_percentile":7061.16,"90th_percentile":8996.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"24","median_amount":6427.68,"10th_percentile":4797.96,"90th_percentile":7196.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5911.12,"10th_percentile":5911.12,"90th_percentile":5911.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9948.15,"maximum":18005.71,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18005.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14746.01},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12582.17},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10153.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10597.06},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12518.34},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14004.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14078.34},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10503.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17005.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14757.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10173.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14747.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9948.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9176.76,"maximum":20507.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12769.63},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10895.81},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11564.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9176.76},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10840.53},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11393.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15950.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12191.45},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11393.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11962.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19368.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12779.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11586.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11393.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11393.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12770.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11393.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11330.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11393.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11393.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7660.99,"maximum":14711.8,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14711.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10660.42},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9096.1},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8295.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7660.99},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9049.96},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8173.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11442.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10177.74},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8173.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13894.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10668.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8312.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8173.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8173.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10661.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8173.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8128.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8173.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8173.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7741.93,"10th_percentile":7741.93,"90th_percentile":7741.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7613.49,"10th_percentile":7613.49,"90th_percentile":7613.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":8862.71,"10th_percentile":8862.71,"90th_percentile":8862.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7911.49,"10th_percentile":249.28,"90th_percentile":8216.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":44310.75,"maximum":80200.46,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80200.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":67248.77},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":57380.65},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45224.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":48327.59},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57089.55},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44555.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62378.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64203.91},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44555.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46783.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75744.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67301.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45313.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44555.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44555.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67254.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":44555.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44310.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":44555.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44555.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13304.84,"maximum":25112.47,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25112.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18513.94},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15797.2},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14160.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13304.84},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15717.06},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13951.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19531.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17675.68},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13951.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23717.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18528.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14188.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13951.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13951.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18515.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13951.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13874.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13951.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13951.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10332.17,"maximum":18700.76,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18700.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14677.86},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12524.02},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10545.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10548.08},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12460.48},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10389.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14545.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14013.28},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10389.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10908.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17661.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14689.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10565.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10389.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10389.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14679.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10389.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10332.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10389.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10389.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9920.53,"maximum":18672.95,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18672.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13804.6},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11778.91},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10529.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9920.53},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11719.15},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10373.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14523.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13179.56},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10373.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10892.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17635.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13815.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10373.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10373.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13805.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10373.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10373.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10373.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16027.32,"maximum":29008.73,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29008.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23081.21},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19694.26},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16357.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16587.06},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19594.35},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16115.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22562.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22036.15},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16115.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16921.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27397.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23099.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16389.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16115.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16115.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23083.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16115.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16027.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16115.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16115.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9544.35,"10th_percentile":212.5,"90th_percentile":21378.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":19419.88,"10th_percentile":19419.88,"90th_percentile":19419.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15212.95,"10th_percentile":15212.95,"90th_percentile":15212.95,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7692.52,"10th_percentile":7692.52,"90th_percentile":7692.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":76307.17,"10th_percentile":76307.17,"90th_percentile":76307.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":22492.97,"10th_percentile":22492.97,"90th_percentile":22492.97,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":21400.05,"10th_percentile":21400.05,"90th_percentile":21400.05,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":10591.05,"10th_percentile":10591.05,"90th_percentile":10591.05,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":24207.41,"10th_percentile":24207.41,"90th_percentile":24207.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":11096.06,"10th_percentile":11096.06,"90th_percentile":20429.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13270.91,"10th_percentile":125.0,"90th_percentile":15261.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12251.45,"maximum":22391.82,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22391.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17048.12},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14546.47},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12626.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12251.45},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14472.68},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12439.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17415.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16276.23},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12439.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13061.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21147.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17061.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12651.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12439.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12439.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17049.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12439.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12371.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12439.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12439.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":11953.67,"10th_percentile":11953.67,"90th_percentile":11953.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":12450.58,"10th_percentile":12450.58,"90th_percentile":12450.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12321.01,"10th_percentile":12321.01,"90th_percentile":12321.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":29682.25,"maximum":53723.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53723.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45388.5},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":38728.17},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30294.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":32617.95},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38531.7},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29846.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43333.42},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29846.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31338.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50738.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45423.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30353.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29846.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29846.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45392.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":29846.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29682.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":29846.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29846.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26879.94,"10th_percentile":26879.94,"90th_percentile":26879.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9245.21,"maximum":16733.41,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16733.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13737.6},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11721.74},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9435.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9872.38},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11662.28},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9296.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13014.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13115.6},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9296.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15803.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13748.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9454.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9296.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9296.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13738.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9296.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9296.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9296.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":28279.3,"maximum":51184.26,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51184.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44597.26},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":38053.03},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28862.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":32049.33},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37859.99},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28435.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39809.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42578.01},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28435.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29857.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48340.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44632.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28919.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28435.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28435.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44601.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28435.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28279.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":28435.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28435.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":12071.23,"10th_percentile":12071.23,"90th_percentile":12071.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39981.38,"10th_percentile":39981.38,"90th_percentile":39981.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13712.25,"maximum":24818.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24818.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20073.33},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17127.76},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13994.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14425.48},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17040.87},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13788.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19303.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19164.46},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13788.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14477.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23439.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20088.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14022.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13788.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13788.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20075.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13788.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13712.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13788.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13788.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6316.24,"10th_percentile":6316.24,"90th_percentile":6316.24,"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":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8465.36,"maximum":16029.09,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11779.71},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10051.15},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9038.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8465.36},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10000.16},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8905.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12467.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11246.35},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8905.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9350.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15138.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11788.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9056.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8905.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8905.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11780.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8905.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8856.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8905.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8905.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17525.9,"maximum":33494.15,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33494.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24387.63},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":20808.97},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18886.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17525.9},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20703.41},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18607.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26051.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23283.42},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18607.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19538.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31633.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24406.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18924.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18607.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18607.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24389.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18607.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18505.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18607.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18607.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18402.15,"10th_percentile":18402.15,"90th_percentile":18402.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":4705.84,"maximum":9916.6,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9916.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":6548.26},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":5587.37},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5591.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4705.84},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5559.02},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5509.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7712.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6251.77},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5509.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9365.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6553.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5602.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5509.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5509.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6548.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5509.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5478.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":5509.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5509.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6473.47,"10th_percentile":6473.47,"90th_percentile":6473.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7574.66,"maximum":15007.03,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15007.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10540.29},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8993.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8462.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7574.66},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8947.98},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8337.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11672.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10063.05},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8337.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8754.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14173.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10548.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8337.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8337.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10541.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8337.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8291.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8337.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8337.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":19394.98,"maximum":35104.03,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35104.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28282.62},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":24132.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19794.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20325.0},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24009.99},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19502.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27303.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27002.06},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19502.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20477.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33153.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28304.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19833.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19502.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19502.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28285.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19502.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19394.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19502.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19502.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18233.81,"10th_percentile":18233.81,"90th_percentile":18233.81,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18415.22,"10th_percentile":18263.02,"90th_percentile":26281.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":76829.34,"maximum":139057.63,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139057.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":123001.98},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":104952.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78413.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":88394.03},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":104420.17},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77254.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108155.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117432.76},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77254.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81116.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131332.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123097.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78567.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77254.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77254.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123012.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":77254.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76829.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":77254.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77254.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":89318.31,"maximum":161662.1,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161662.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":151328.5},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":129122.47},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":91159.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":108750.57},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":128467.43},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89812.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125737.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144476.73},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89812.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94302.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":152680.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151446.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91339.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89812.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89812.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151341.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":89812.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89318.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":89812.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89812.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":43326.93,"maximum":78419.79,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78419.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65894.99},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":56225.52},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44220.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":47354.71},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55940.29},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43566.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60993.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62911.43},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43566.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45744.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74063.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65946.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44307.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43566.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43566.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65900.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":43566.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43326.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":43566.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43566.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":34185.13,"maximum":61873.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61873.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48402.16},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":41299.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34889.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":34783.68},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41090.08},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34374.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48123.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46210.63},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34374.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36092.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58436.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48439.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34958.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34374.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34374.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48406.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":34374.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34185.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":34374.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34374.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9448.2,"maximum":18118.22,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18118.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13147.35},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11218.1},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10216.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9448.2},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11161.19},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10065.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14091.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12552.07},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10065.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10568.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17111.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13157.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10065.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10065.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13148.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10065.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10010.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10065.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10065.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":13246.33,"10th_percentile":13246.33,"90th_percentile":13422.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":9120.97,"10th_percentile":9120.97,"90th_percentile":9120.97,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9115.77,"10th_percentile":9115.77,"90th_percentile":9928.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18404.58,"maximum":33311.45,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33311.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28923.7},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":24679.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20785.7},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24554.22},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18506.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25908.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27614.11},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18506.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19431.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31460.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28946.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18820.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18506.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18506.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28926.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18506.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18404.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18506.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18506.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29438.46,"10th_percentile":29438.46,"90th_percentile":29438.46,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":9674.12,"10th_percentile":9674.12,"90th_percentile":9674.12,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18997.67,"10th_percentile":18997.67,"90th_percentile":18997.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16121.68,"maximum":29179.51,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29179.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22976.09},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19604.57},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16454.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16511.52},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19505.11},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16210.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22695.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21935.79},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16210.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17021.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27558.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22994.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16486.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16210.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16210.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22978.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16210.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16121.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16210.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16210.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":22825.86,"10th_percentile":22825.86,"90th_percentile":22825.86,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":22979.24,"10th_percentile":22979.24,"90th_percentile":22979.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16050.36,"10th_percentile":15902.36,"90th_percentile":40089.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6226.58,"maximum":12567.06,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12567.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8664.41},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7392.99},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7086.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6226.58},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7355.48},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9774.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8272.1},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6981.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7330.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11868.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8671.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7100.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8665.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6981.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6981.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6294.04,"10th_percentile":6294.04,"90th_percentile":6294.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14651.44,"maximum":26518.45,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26518.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22961.08},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19591.76},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14953.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16500.73},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19492.37},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14732.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20625.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21921.46},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14732.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15469.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25045.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22978.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14982.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14732.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14732.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22963.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14732.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14732.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14732.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11299.89,"maximum":20452.28,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20452.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16293.84},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13902.87},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11532.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11709.39},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13832.34},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15907.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15556.1},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11362.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11930.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19316.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16306.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11555.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16295.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11362.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11299.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11362.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":19897.5,"maximum":36701.98,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36701.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27687.75},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":23624.83},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20695.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19897.5},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23504.98},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20389.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28545.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26434.12},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20389.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21409.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34662.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27709.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20736.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20389.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20389.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27690.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20389.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20277.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":20389.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20389.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18609.38,"maximum":33682.14,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33682.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26065.99},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22241.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18992.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18732.04},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22128.22},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18712.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26197.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24885.78},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18712.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19647.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31810.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26086.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19030.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18712.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18712.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26068.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18712.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18609.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18712.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18712.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10822.84,"maximum":20072.32,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20072.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15060.19},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12850.25},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11318.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10822.84},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12785.06},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11151.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15611.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14378.31},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11151.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11708.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18957.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15071.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11151.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11151.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15061.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11151.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11089.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11151.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11151.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17365.9,"maximum":31431.49,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31431.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24815.01},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21173.64},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17723.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17833.04},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21066.23},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24446.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23691.45},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17461.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18335.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29685.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24834.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17758.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24817.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17461.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17365.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17461.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6205.0,"maximum":12506.17,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12506.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8634.37},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7367.36},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7052.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6205.0},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7329.99},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6947.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9727.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8243.43},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6947.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11811.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8641.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7065.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6947.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6947.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8635.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6947.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6909.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6947.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6947.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8634.37,"10th_percentile":8634.37,"90th_percentile":8634.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3033.36,"10th_percentile":3033.36,"90th_percentile":3033.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":265.52,"10th_percentile":247.33,"90th_percentile":6325.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6428.97,"10th_percentile":6428.97,"90th_percentile":6428.97,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13592.06,"maximum":25284.56,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25284.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18913.61},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16138.21},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14257.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13592.06},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16056.34},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14046.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19665.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18057.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14046.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14749.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23879.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18928.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14285.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14046.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14046.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18915.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14046.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13969.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14046.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14046.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11237.89,"maximum":20645.59,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20645.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15637.74},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13343.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11641.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11237.89},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13275.36},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11469.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16057.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14929.71},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11469.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12043.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19498.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15649.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11664.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11469.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11469.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15639.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11469.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11406.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11469.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11469.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9215.77,"maximum":16734.74,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16734.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12823.92},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10942.13},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9436.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9215.77},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10886.62},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9297.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13015.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12243.29},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9297.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15805.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12833.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9297.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9297.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12825.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9297.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9297.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9297.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8723.56,"10th_percentile":8723.56,"90th_percentile":8723.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10272.49,"maximum":18911.25,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18911.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14294.36},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12196.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10663.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10272.49},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12134.93},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10506.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14708.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13647.15},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10506.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17860.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14305.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10506.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10506.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14295.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10506.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10448.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10506.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10506.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":13120.18,"10th_percentile":13120.18,"90th_percentile":13120.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":9829.58,"10th_percentile":8416.62,"90th_percentile":10404.86,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7400.39,"10th_percentile":6706.97,"90th_percentile":10271.66,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":21702.24,"10th_percentile":21702.24,"90th_percentile":21702.24,"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":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":12899.09,"10th_percentile":12899.09,"90th_percentile":13340.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":9726.44,"10th_percentile":9726.44,"90th_percentile":9874.62,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":20252.51,"10th_percentile":20252.51,"90th_percentile":20252.51},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8048.77,"10th_percentile":8048.77,"90th_percentile":8048.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":13498.76,"10th_percentile":13498.76,"90th_percentile":14279.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8909.52,"10th_percentile":8909.52,"90th_percentile":8909.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":9709.34,"10th_percentile":6715.3,"90th_percentile":10255.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9910.8,"10th_percentile":9910.8,"90th_percentile":9910.8,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8217.16,"maximum":15120.9,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15120.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11434.33},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9756.45},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8526.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8217.16},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9706.96},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8400.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11760.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10916.62},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8400.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8820.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14280.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11443.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8400.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8400.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11435.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8400.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8400.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8400.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14805.05,"maximum":26796.47,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26796.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21804.82},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18605.17},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15110.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15669.8},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18510.79},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20841.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20817.56},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15631.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25307.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21821.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15140.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21806.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14805.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14886.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":12629.88,"10th_percentile":12629.88,"90th_percentile":12629.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7725.03,"10th_percentile":7725.03,"90th_percentile":7725.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":49383.48,"maximum":89606.84,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89606.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":68718.05},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":58634.33},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50528.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":49383.48},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58336.87},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69694.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65606.67},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52270.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84628.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68771.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50627.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68724.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49507.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":57333.69,"maximum":103771.39,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103771.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":90280.31},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":77032.52},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58515.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":64878.96},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76641.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57650.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80711.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86192.64},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57650.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60533.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98006.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90350.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58630.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57650.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57650.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90288.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":57650.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57333.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":57650.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57650.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16998.71,"maximum":30766.9,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30766.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26020.94},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22202.61},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17349.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18699.66},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22089.98},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17092.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23929.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24842.78},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17092.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17947.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29057.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26041.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17383.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17092.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17092.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26023.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17092.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16998.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17092.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17092.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16350.51,"10th_percentile":16350.51,"90th_percentile":16350.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16857.95,"10th_percentile":16857.95,"90th_percentile":17030.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17127.54,"10th_percentile":17127.54,"90th_percentile":17127.54,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":21142.43,"maximum":38266.85,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38266.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30220.88},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":25786.25},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21578.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21717.91},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25655.44},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29763.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28852.56},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21259.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22322.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36140.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30244.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21620.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30223.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21259.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21142.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":21259.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":22262.45,"maximum":43032.94,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43032.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30978.63},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":26432.81},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24265.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22262.45},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26298.71},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23907.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33470.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29575.99},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23907.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25102.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40642.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31002.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24313.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23907.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23907.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30981.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23907.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23775.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":23907.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23907.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":84299.76,"maximum":152578.75,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":152578.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":127288.55},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":108610.16},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":86037.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":91474.53},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":108059.18},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84765.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118672.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121525.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84765.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89004.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144102.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127387.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86206.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84765.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84765.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127299.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":84765.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84299.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":84765.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84765.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":41306.64,"maximum":74763.14,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74763.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":62324.58},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":53179.03},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42158.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":44788.88},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52909.25},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41535.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58149.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59502.68},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41535.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43611.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70609.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62373.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42241.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41535.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41535.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62329.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":41535.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41306.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":41535.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41535.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":58969.25,"maximum":106731.67,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106731.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":93106.84},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":79444.29},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60184.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":66910.21},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79041.26},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59295.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83013.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88891.19},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59295.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62260.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100802.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93179.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60303.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59295.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59295.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93114.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":59295.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58969.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":59295.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59295.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":45360.4,"maximum":82100.27,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82100.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":70219.68},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":59915.61},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46295.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":50462.61},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59611.65},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45611.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63855.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67040.31},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45611.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47891.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77539.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70274.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46386.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45611.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45611.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70225.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":45611.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45360.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":45611.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45611.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15215.73,"maximum":28276.61,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28276.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21172.98},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18066.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15944.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15215.73},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17974.4},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15709.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21992.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20214.32},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15709.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16494.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26705.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21189.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15976.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15709.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15709.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21174.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15709.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15622.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15709.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15709.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7647.71,"maximum":15519.38,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15519.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10641.94},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9080.33},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8751.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7647.71},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9034.27},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8621.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12070.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10160.1},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8621.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9052.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14657.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10650.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8768.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8621.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8621.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10642.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8621.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8574.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8621.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8621.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":21579.12,"maximum":39057.23,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39057.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31224.66},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":26642.74},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22023.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22439.26},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26507.58},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21698.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30377.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29810.89},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21698.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22783.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36887.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31248.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22067.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21698.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21698.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31227.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21698.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21579.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":21698.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21698.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14138.3,"10th_percentile":14138.3,"90th_percentile":14138.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21595.92,"10th_percentile":21595.92,"90th_percentile":21595.92,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6642.46,"maximum":13131.05,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13131.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9243.11},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7886.77},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7404.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6642.46},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7846.76},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10213.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8824.61},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7295.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7659.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9250.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7419.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9243.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7295.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7254.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7295.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":869.46,"10th_percentile":869.46,"90th_percentile":869.46,"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":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8563.78,"10th_percentile":8563.78,"90th_percentile":8563.78,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":6131.8,"10th_percentile":6131.8,"90th_percentile":6131.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":265.53,"10th_percentile":119.0,"90th_percentile":6739.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6802.81,"10th_percentile":6802.81,"90th_percentile":6802.81,"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":"Wellcare","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":4688.73,"10th_percentile":4688.73,"90th_percentile":4688.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12835.01,"maximum":17874.07,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17860.16},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15239.35},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12835.01},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15162.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17051.49},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17874.07},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17861.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18030.07,"maximum":32633.6,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32633.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26173.41},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22332.71},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18401.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18809.24},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22219.42},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18129.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25381.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24988.35},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18129.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19036.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30820.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26193.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18437.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18129.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18129.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26175.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18129.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18030.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18129.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18129.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6551.98,"maximum":13097.95,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13097.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9117.2},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7779.34},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7385.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6551.98},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7739.88},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7276.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10187.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8704.4},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7276.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7640.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12370.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9124.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7400.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7276.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7276.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9117.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7276.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7276.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7276.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":119.0,"10th_percentile":119.0,"90th_percentile":119.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9244.8,"10th_percentile":9244.8,"90th_percentile":9244.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2299.15,"10th_percentile":2299.15,"90th_percentile":2299.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7650.2,"maximum":14505.28,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14505.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10645.4},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9083.29},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8179.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7650.2},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9037.21},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8058.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11281.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10163.4},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8058.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13699.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10653.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8195.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8058.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8058.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10646.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8058.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8014.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8058.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8058.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10798.91,"10th_percentile":10798.91,"90th_percentile":10798.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8798.55,"10th_percentile":8798.55,"90th_percentile":8798.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7532.48,"10th_percentile":7532.48,"90th_percentile":7532.48,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4997.15,"10th_percentile":4997.15,"90th_percentile":4997.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":8699.82,"10th_percentile":8699.82,"90th_percentile":8699.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":9873.9,"10th_percentile":9873.9,"90th_percentile":9873.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5434.73,"10th_percentile":5434.73,"90th_percentile":5434.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7591.78,"10th_percentile":7591.78,"90th_percentile":7591.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9654.89,"maximum":17956.71,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17956.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13434.97},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11463.51},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10125.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9654.89},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11405.36},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9975.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13966.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12826.67},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9975.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10474.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16959.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13445.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10145.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9975.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9975.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13436.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9975.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9921.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9975.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9975.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6752.86,"maximum":14288.15,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14288.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9396.74},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8017.86},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8056.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6752.86},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7977.18},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7937.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11113.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8971.28},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7937.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8334.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13494.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9404.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8072.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7937.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7937.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9397.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7937.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7894.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7937.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7937.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16899.96,"maximum":30588.16,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30588.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26496.84},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22608.68},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17248.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19041.66},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22493.98},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16993.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23790.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25297.13},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16993.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17843.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28888.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26517.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17282.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16993.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16993.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26499.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16993.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16899.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16993.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16993.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15191.95,"10th_percentile":15191.95,"90th_percentile":15191.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12848.39,"maximum":23255.01,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23255.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18784.24},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16027.83},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13113.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13499.09},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15946.52},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12919.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18087.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17933.73},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12919.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13565.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21963.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18798.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12919.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12919.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18785.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12919.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12848.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12919.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12919.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12605.17,"10th_percentile":12605.17,"90th_percentile":12605.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15413.63,"maximum":27897.97,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27897.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21529.91},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18370.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15731.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15472.23},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18277.4},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15498.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21698.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20555.09},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15498.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16273.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26348.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21546.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15762.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15498.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15498.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21531.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15498.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15413.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15498.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15498.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8235.42,"maximum":15477.03,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15477.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11459.75},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9778.14},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8727.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8235.42},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9728.53},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12037.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10940.88},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8598.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14617.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11468.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8744.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11460.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8598.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8551.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8598.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10157.59,"10th_percentile":10157.59,"90th_percentile":10157.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5566.09,"10th_percentile":5566.09,"90th_percentile":5566.09,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6909.63,"10th_percentile":6909.63,"90th_percentile":6909.63,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":8043.33,"10th_percentile":5577.89,"90th_percentile":8122.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12811.82,"maximum":23188.81,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23188.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18250.58},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15572.48},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13075.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13115.58},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15493.48},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12882.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18035.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17424.24},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12882.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13526.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21900.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18264.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12882.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12882.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18252.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12882.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12811.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12882.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12882.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6466.95,"10th_percentile":6466.95,"90th_percentile":6466.95,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":21395.02,"10th_percentile":21395.02,"90th_percentile":21395.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8190.37,"10th_percentile":8190.37,"90th_percentile":11176.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6806.82,"maximum":13225.05,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13225.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9471.82},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8081.92},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7457.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6806.82},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8040.92},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7347.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10286.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9042.96},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7347.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7714.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12490.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9479.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7347.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7347.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9472.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7347.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7306.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7347.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7347.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9471.82,"10th_percentile":9471.82,"90th_percentile":9471.82,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8723.56,"10th_percentile":8723.56,"90th_percentile":8723.56,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":14438.31,"10th_percentile":14438.31,"90th_percentile":14438.31,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":5792.74,"10th_percentile":609.43,"90th_percentile":7063.74,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":19763.96,"10th_percentile":19763.96,"90th_percentile":19763.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":6874.73,"10th_percentile":5699.26,"90th_percentile":6991.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","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":7548.0,"10th_percentile":7548.0,"90th_percentile":7548.0,"additional_payer_notes":"Contracting method is an algorithm described in 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":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8024.58,"maximum":15413.47,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15413.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11166.35},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9527.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8691.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8024.58},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9479.46},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11988.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10660.77},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8563.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8991.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14557.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11175.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11167.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8563.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8515.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8563.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":1392.05,"10th_percentile":1392.05,"90th_percentile":1392.05,"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":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10941.64,"10th_percentile":10941.64,"90th_percentile":10941.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8051.72,"10th_percentile":8051.72,"90th_percentile":8051.72,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4730.29,"10th_percentile":4730.29,"90th_percentile":4730.29},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8305.49,"10th_percentile":8305.49,"90th_percentile":8305.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10414.01,"10th_percentile":10414.01,"90th_percentile":10414.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":119.0,"10th_percentile":119.0,"90th_percentile":119.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7905.58,"10th_percentile":7889.06,"90th_percentile":7942.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":74243.62,"maximum":134377.6,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134377.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":122373.6},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":104416.44},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75774.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":87942.45},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":103886.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74654.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104515.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116832.84},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74654.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78386.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126912.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122468.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75923.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74654.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74654.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122384.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":74654.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74243.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":74654.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74654.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":24449.37,"maximum":44252.26,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44252.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35878.56},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":30613.72},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24953.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25783.74},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30458.42},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34418.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34254.07},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25813.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41793.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35906.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25002.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35881.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24449.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":24584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24584.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":29593.62,"10th_percentile":29593.62,"90th_percentile":29593.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23064.61,"10th_percentile":23064.61,"90th_percentile":23066.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":22262.3,"maximum":40293.76,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40293.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33636.51},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":28700.67},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22721.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24172.51},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28555.07},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22385.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31339.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32113.54},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22385.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38055.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33662.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22765.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22385.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22385.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33639.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22385.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22262.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":22385.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22385.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":29653.16,"10th_percentile":29653.16,"90th_percentile":29653.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":26316.04,"10th_percentile":26316.04,"90th_percentile":26316.04,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21474.12,"10th_percentile":21474.12,"90th_percentile":21474.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":26927.57,"maximum":48737.68,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48737.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39622.24},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":33808.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27482.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":28474.09},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33636.54},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37907.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37828.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28430.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46030.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39653.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27536.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39625.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26927.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":27076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27076.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25436.41,"10th_percentile":25436.41,"90th_percentile":25436.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":25204.98,"maximum":45619.87,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45619.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39351.95},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":33577.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25724.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":28279.85},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33407.08},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25344.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35482.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37570.19},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25344.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26611.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43085.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39382.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25775.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25344.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25344.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39355.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25344.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25204.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":25344.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25344.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":51721.19,"maximum":93613.01,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93613.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":77012.83},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":65711.92},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52787.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":55344.43},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65378.56},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52007.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72810.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73525.88},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52007.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54607.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88412.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77072.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52891.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52007.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52007.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77019.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":52007.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51721.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":52007.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52007.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":45347.97,"maximum":82077.77,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82077.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":71546.89},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":61048.06},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46282.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":51416.39},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60738.36},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45598.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63838.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68307.43},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45598.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47878.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77517.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71602.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46373.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45598.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45598.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71553.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":45598.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45347.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":45598.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45598.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44893.41,"10th_percentile":44893.41,"90th_percentile":44893.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6150.21,"maximum":11719.76,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11719.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8558.14},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7302.31},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6608.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6150.21},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7265.27},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6510.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9115.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8170.65},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6510.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11068.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8564.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6621.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6510.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6510.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8558.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6510.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6475.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6510.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6510.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7149.65,"maximum":13795.65,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13795.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9948.88},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8488.97},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7779.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7149.65},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8445.91},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10729.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9498.42},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7664.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8047.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13029.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9956.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7794.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9949.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7664.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7622.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7664.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6450.41,"10th_percentile":6450.41,"90th_percentile":6450.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5897.17,"10th_percentile":5897.17,"90th_percentile":5897.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8886.22,"maximum":16688.41,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16688.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12365.35},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10550.85},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9410.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8886.22},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10497.32},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9271.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12979.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11805.47},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9271.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9734.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15761.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12374.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9428.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9271.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9271.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12366.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9271.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9271.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9271.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":11280.5,"10th_percentile":11280.5,"90th_percentile":11280.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8621.39,"10th_percentile":8599.48,"90th_percentile":8646.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10011.01,"maximum":18495.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18495.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13930.51},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11886.34},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10429.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10011.01},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11826.04},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14385.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13299.77},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10789.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17468.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13941.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10449.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13931.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":13222.7,"10th_percentile":12591.2,"90th_percentile":85785.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10176.3,"10th_percentile":10176.3,"90th_percentile":10176.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8536.4,"10th_percentile":8536.4,"90th_percentile":8536.4,"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":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":13930.56,"10th_percentile":13930.56,"90th_percentile":13930.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9530.59,"10th_percentile":8055.9,"90th_percentile":9652.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5666.26,"maximum":11586.04,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11586.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7884.71},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6727.71},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6533.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5666.26},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6693.58},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6436.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9011.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7527.71},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6436.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6758.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10942.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7890.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6546.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6436.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6436.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7885.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6436.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6401.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6436.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6436.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":128.33,"10th_percentile":128.33,"90th_percentile":128.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":23757.46,"maximum":45058.52,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45058.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33058.96},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":28207.87},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25408.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":23757.46},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28064.77},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25032.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35045.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31562.14},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25032.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26284.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42555.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33084.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25458.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25032.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25032.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33061.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25032.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24894.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":25032.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25032.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17640.46,"maximum":33564.31,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33564.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24547.03},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":20944.99},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18926.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17640.46},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20838.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18646.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26105.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23435.6},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18646.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19579.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31699.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24566.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18963.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18646.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18646.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24549.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18646.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18544.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18646.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18646.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18203.43,"maximum":32947.38,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32947.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27336.6},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":23325.21},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18578.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19645.15},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23206.88},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25625.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26098.86},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18304.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19219.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31116.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27357.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18615.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27338.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18304.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18203.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18304.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18304.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11066.06,"maximum":20362.27,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20362.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15398.64},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13139.03},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11482.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11066.06},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13072.38},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11312.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15837.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14701.43},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11312.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11877.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19231.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15410.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11504.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11312.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11312.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15399.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11312.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11250.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11312.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11312.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8544.22,"maximum":16072.79,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16072.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11889.44},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10144.78},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9063.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8544.22},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10093.32},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8929.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12501.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11351.12},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8929.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15179.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11898.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9081.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8929.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8929.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11890.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8929.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8880.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8929.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8929.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7993.65,"10th_percentile":7993.65,"90th_percentile":7993.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":12489.44,"10th_percentile":12489.44,"90th_percentile":12489.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7631.48,"10th_percentile":7278.55,"90th_percentile":8399.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15764.73,"maximum":28533.46,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28533.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22227.59},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18965.9},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16089.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15973.61},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18869.69},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15851.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22192.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21221.18},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15851.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16644.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26948.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22244.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16121.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15851.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15851.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22229.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15851.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15764.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15851.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15851.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12202.47,"maximum":22107.19,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22107.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16979.97},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14488.32},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12466.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12202.47},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14414.82},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12281.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17194.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16211.16},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12281.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20879.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16993.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12490.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12281.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12281.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16981.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12281.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12281.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12281.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":13535.19,"10th_percentile":13535.19,"90th_percentile":13535.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11482.72,"10th_percentile":5710.28,"90th_percentile":11514.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18929.76,"maximum":34262.01,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34262.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28618.76},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":24419.23},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19319.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20566.56},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24295.35},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19034.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26648.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27322.97},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19034.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19986.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32358.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28641.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19358.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19034.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19034.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28621.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19034.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18929.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19034.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19034.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":26050.61,"10th_percentile":26050.61,"90th_percentile":26050.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17025.29,"10th_percentile":17025.29,"90th_percentile":17025.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18424.52,"10th_percentile":18407.29,"90th_percentile":18563.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17338.1,"maximum":31381.18,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31381.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24214.36},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":20661.13},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17695.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17401.39},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20556.32},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17433.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24407.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23118.0},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17433.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18305.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24233.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17730.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17433.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17433.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24216.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17433.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17338.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17433.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17433.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":25149.99,"10th_percentile":25149.99,"90th_percentile":25149.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18867.59,"maximum":34149.49,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34149.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27450.95},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":23422.78},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19256.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19727.33},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23303.96},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18971.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26560.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26208.04},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18971.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19920.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32252.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27472.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19294.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18971.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18971.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27453.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18971.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18867.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18971.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18971.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":15524.88,"10th_percentile":15524.88,"90th_percentile":15524.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17741.66,"10th_percentile":17741.66,"90th_percentile":17741.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12386.11,"maximum":22418.3,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22418.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17854.38},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15234.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12641.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12830.86},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15157.13},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12454.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17436.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17045.98},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12454.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13077.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21172.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17868.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12666.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12454.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12454.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17855.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12454.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12386.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12454.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12454.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5780.82,"maximum":11988.52,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11988.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8044.12},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6863.72},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6760.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5780.82},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6828.9},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6660.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9324.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7679.9},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6660.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6993.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11322.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8050.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6773.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6660.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6660.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8044.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6660.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6623.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6660.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6660.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8020.43,"maximum":15335.37,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15335.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11160.58},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9522.87},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8647.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8020.43},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9474.56},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8519.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11927.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10655.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8519.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8945.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14483.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11169.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8664.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8519.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8519.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11161.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8519.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8472.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8519.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8519.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":25041.12,"maximum":45323.3,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45323.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35644.08},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":30413.64},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25557.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25615.23},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30259.35},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35251.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34030.2},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25179.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26438.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42805.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35671.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25607.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35647.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25179.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25041.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":25179.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22579.52,"10th_percentile":22579.52,"90th_percentile":22579.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14409.71,"maximum":26699.83,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26699.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20051.38},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17109.03},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15055.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14409.71},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17022.24},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20766.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19143.51},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14833.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15574.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25216.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20067.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15085.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20053.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14833.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14751.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14833.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":19269.16,"maximum":34876.31,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34876.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27343.53},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":23331.12},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19666.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19650.13},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23212.76},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27126.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26105.48},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19375.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20344.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32938.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27364.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19705.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27345.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19375.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19269.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19375.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":31755.15,"10th_percentile":30513.15,"90th_percentile":32206.05,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17767.16,"10th_percentile":17767.16,"90th_percentile":17767.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":19935.28,"10th_percentile":19935.28,"90th_percentile":19935.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2414.25,"10th_percentile":2414.25,"90th_percentile":2414.25,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":29302.46,"10th_percentile":29302.46,"90th_percentile":31178.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":30754.54,"10th_percentile":30754.54,"90th_percentile":30754.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2398.98,"10th_percentile":2398.98,"90th_percentile":2398.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17532.5,"10th_percentile":17532.5,"90th_percentile":17850.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16732.45,"maximum":30284.98,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30284.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23967.17},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":20450.21},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17077.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17223.74},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20346.47},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16824.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23554.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22882.0},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16824.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17666.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28602.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23985.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17111.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16824.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16824.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23969.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16824.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16732.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16824.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16824.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":13803.21,"10th_percentile":13803.21,"90th_percentile":13803.21,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13378.26,"10th_percentile":13378.26,"90th_percentile":13378.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":15545.88,"10th_percentile":14163.07,"90th_percentile":16039.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":28268.33,"maximum":51164.41,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51164.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41017.6},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":34998.66},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28851.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29476.85},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34821.11},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28424.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39794.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39160.43},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28424.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29845.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48321.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41049.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28907.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28424.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28424.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41021.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28424.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28268.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":28424.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28424.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":24561.29,"maximum":44454.82,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44454.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36599.34},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":31228.74},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25067.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":26301.72},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31070.31},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24697.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34575.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34942.22},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24697.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25931.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41985.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36627.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25116.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24697.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24697.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36602.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24697.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24561.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":24697.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24697.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10713.27,"maximum":22604.98,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22604.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14907.72},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12720.15},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12746.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10713.27},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12655.62},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12558.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17581.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14232.74},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12558.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13186.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21349.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14919.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12771.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12558.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12558.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14909.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12558.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12489.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12558.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12558.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8625.73,"10th_percentile":8625.73,"90th_percentile":8625.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16612.5,"maximum":30067.87,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30067.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23235.99},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19826.33},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16954.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16698.29},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19725.75},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16704.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23386.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22183.92},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16704.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17539.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28397.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23254.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16988.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16704.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16704.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23238.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16704.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16612.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16704.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16704.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15194.29,"10th_percentile":15194.29,"90th_percentile":15194.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13671.38,"10th_percentile":7603.87,"90th_percentile":15277.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6756.18,"maximum":13227.7,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13227.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9401.36},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8021.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7458.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6756.18},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7981.1},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7348.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10288.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8975.69},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7348.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7716.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12492.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9408.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7473.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7348.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7348.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9402.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7348.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7308.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7348.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7348.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":265.53,"10th_percentile":265.53,"90th_percentile":265.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14333.26,"maximum":25942.55,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25942.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21541.46},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18380.45},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14628.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15480.53},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18287.21},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14412.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20177.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20566.12},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14412.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15133.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24501.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21558.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14657.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14412.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14412.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21543.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14412.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14333.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14412.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14412.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14141.98,"10th_percentile":14141.98,"90th_percentile":14141.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7156.29,"maximum":14127.97,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14127.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9958.12},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8496.86},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7966.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7156.29},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8453.75},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10988.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9507.24},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8241.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13343.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9965.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7982.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9958.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7805.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7848.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7848.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7170.4,"maximum":14380.83,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14380.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9977.75},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8513.61},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8109.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7170.4},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8470.42},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11185.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9525.99},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7989.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8388.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13581.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9985.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8125.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9978.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7989.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7945.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7989.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9977.75,"10th_percentile":9977.75,"90th_percentile":9977.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6558.03,"10th_percentile":6558.03,"90th_percentile":6558.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":7073.91,"10th_percentile":7073.91,"90th_percentile":7073.91,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7183.56,"10th_percentile":7183.56,"90th_percentile":7183.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6209.15,"maximum":12475.71,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12475.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8640.15},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7372.29},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7034.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6209.15},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7334.89},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6930.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9703.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8248.94},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6930.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7277.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11782.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8646.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6930.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6930.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8640.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6930.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6892.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6930.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6930.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":20800.84,"maximum":37648.58,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37648.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30755.69},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":26242.59},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21229.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22102.24},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26109.46},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20915.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29282.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29363.15},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20915.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21961.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35557.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30779.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20915.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20915.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30758.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20915.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20800.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":20915.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20915.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19867.76,"10th_percentile":19867.76,"90th_percentile":19867.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15522.61,"maximum":28095.23,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28095.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22928.74},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19564.16},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15842.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16477.49},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19464.91},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15608.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21851.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21890.58},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15608.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16388.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26534.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22946.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15608.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15608.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22930.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15608.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15608.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15608.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7039.86,"maximum":12741.82,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12741.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9874.95},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8425.89},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7184.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7096.52},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8383.15},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7078.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9910.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9427.84},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7078.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7432.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12033.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9882.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7199.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7078.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7078.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9875.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7078.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7039.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7078.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7078.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7174.55,"maximum":14555.57,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14555.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9983.53},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8518.54},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8207.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7174.55},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8475.33},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8086.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11321.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9531.5},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8086.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8490.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13746.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9991.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8223.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8086.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8086.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9984.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8086.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8041.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8086.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8086.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12133.57,"maximum":22525.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22525.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16884.1},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14406.52},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12701.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12133.57},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14333.43},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12514.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17519.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16119.63},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12514.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21274.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16897.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12726.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12514.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12514.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16885.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12514.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12445.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12514.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12514.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17349.07,"maximum":31401.04,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31401.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25990.91},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22176.99},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17706.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18678.08},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22064.48},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17445.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24423.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24814.1},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17445.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18317.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29656.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26011.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17741.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17445.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17445.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25993.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17445.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17349.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17445.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17445.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":11988.19,"10th_percentile":11988.19,"90th_percentile":11988.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16971.25,"10th_percentile":16971.25,"90th_percentile":16971.25,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":23594.92,"10th_percentile":23594.92,"90th_percentile":23594.92,"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 Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18685.77,"10th_percentile":18685.77,"90th_percentile":18685.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13452.58,"maximum":24348.56,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24348.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19143.47},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16334.35},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13729.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13757.25},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16251.48},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13526.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18937.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18276.7},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13526.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14203.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22995.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19158.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13756.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13526.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13526.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19145.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13526.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13452.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13526.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13526.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13394.39,"10th_percentile":13394.39,"90th_percentile":13394.39,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":17323.75,"10th_percentile":17323.75,"90th_percentile":17323.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12833.08,"10th_percentile":12833.08,"90th_percentile":12833.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16894.11,"maximum":30577.57,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30577.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23993.74},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":20472.88},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17242.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17242.84},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20369.02},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23782.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22907.36},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16987.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17836.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28878.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24012.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17276.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23995.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16987.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16894.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16987.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12531.67,"maximum":22681.76,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22681.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17641.84},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15053.07},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12789.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12678.12},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14976.7},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12600.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17641.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16843.06},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12600.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13231.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21421.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17655.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12815.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12600.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12600.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17643.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12600.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12531.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12600.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12600.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14307.6,"maximum":26319.87,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26319.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19909.3},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16987.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14841.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14307.6},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16901.62},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14622.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20471.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19007.86},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14622.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15353.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24857.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19924.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14870.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14622.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14622.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19911.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14622.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14541.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14622.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14622.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14605.37,"maximum":26435.05,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26435.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21780.57},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18584.47},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14906.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15652.37},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18490.19},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14686.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20560.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20794.4},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14686.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15420.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24966.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21797.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14935.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14686.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14686.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21782.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14686.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14605.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14686.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14686.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5741.8,"maximum":11677.39,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11677.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7989.83},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6817.4},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6584.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5741.8},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6782.81},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9082.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7628.07},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6811.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11028.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7996.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6597.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7990.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6487.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11661.23,"maximum":21106.3,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21106.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17341.52},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14796.81},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11901.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12462.29},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14721.75},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11725.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16416.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16556.34},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11725.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19933.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17355.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11925.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11725.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11725.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17343.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11725.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11661.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11725.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11725.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10225.17,"maximum":20337.1,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20337.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14228.52},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12140.62},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11467.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10225.17},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12079.03},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15817.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13584.29},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11298.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11863.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19207.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14239.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14229.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11298.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11236.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11298.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11298.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":63.75,"10th_percentile":63.75,"90th_percentile":63.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9137.74,"maximum":16571.9,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16571.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12715.34},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10849.48},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9344.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9137.74},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10794.44},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12889.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12139.62},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9206.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9666.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15651.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12725.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9363.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12716.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9206.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9155.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9206.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14648.52,"maximum":26513.15,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26513.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21002.03},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17920.18},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14950.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15092.88},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17829.27},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20621.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20051.11},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15466.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25040.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21018.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14979.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21003.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14729.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11307.62,"maximum":20922.28,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20922.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15734.77},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13425.84},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11797.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11307.62},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13357.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11623.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16272.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15022.34},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11623.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12204.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19759.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15747.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11821.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11623.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11623.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15736.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11623.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11559.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11623.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11623.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5311.81,"maximum":11341.12,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11341.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7391.48},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6306.85},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6395.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5311.81},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6274.86},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6300.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8820.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7056.82},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6300.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6615.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10711.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7397.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6300.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6300.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7392.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6300.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6265.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6300.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6300.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6045.17,"10th_percentile":6045.17,"90th_percentile":6045.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":7057.92,"10th_percentile":7057.92,"90th_percentile":7057.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15290.44,"maximum":35059.01,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35059.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21276.94},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18154.75},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19769.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15290.44},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18062.65},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27268.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20313.58},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20451.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33111.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21293.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19808.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21278.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19370.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19477.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":31102.01,"maximum":56293.24,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56293.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46898.22},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":40016.35},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31743.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":33702.89},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39813.34},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31274.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43783.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44774.78},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31274.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32837.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53165.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46934.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31805.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31274.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31274.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46902.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":31274.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31102.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":31274.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31274.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":4356.0,"10th_percentile":4356.0,"90th_percentile":4356.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":2496.0,"10th_percentile":2496.0,"90th_percentile":2496.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":5488.0,"10th_percentile":5488.0,"90th_percentile":5488.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":5248.0,"10th_percentile":5248.0,"90th_percentile":9568.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":34539.15,"maximum":62514.31,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62514.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54919.23},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":46860.35},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35251.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":39467.1},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46622.63},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34730.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48622.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52432.63},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34730.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36466.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59041.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54962.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35320.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34730.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34730.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54923.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":34730.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34539.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":34730.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34730.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5289.4,"maximum":11481.46,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11481.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7360.3},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6280.24},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6474.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5289.4},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6248.38},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6378.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8930.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7027.04},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6378.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6697.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10843.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7366.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6487.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6378.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6378.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7360.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6378.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6378.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6378.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"11","median_amount":2378.0,"10th_percentile":1366.08,"90th_percentile":4799.97,"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":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"184","median_amount":5882.58,"10th_percentile":4624.22,"90th_percentile":6438.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"42","median_amount":5037.5,"10th_percentile":2425.48,"90th_percentile":6333.39,"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":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"14","median_amount":3446.16,"10th_percentile":3268.5,"90th_percentile":4358.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":7614.45,"10th_percentile":4227.34,"90th_percentile":11796.39},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"34","median_amount":4997.79,"10th_percentile":2414.25,"90th_percentile":4997.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"28","median_amount":5327.17,"10th_percentile":2573.45,"90th_percentile":5327.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":3585.22,"10th_percentile":3585.22,"90th_percentile":3585.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7888.33,"10th_percentile":7888.33,"90th_percentile":7904.04,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"20","median_amount":6248.0,"10th_percentile":4852.46,"90th_percentile":6598.31,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":5791.2,"10th_percentile":4641.5,"90th_percentile":5980.82,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":9841.9,"10th_percentile":9841.9,"90th_percentile":10075.18},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"121","median_amount":6236.0,"10th_percentile":4456.12,"90th_percentile":6758.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"108","median_amount":4797.96,"10th_percentile":2398.98,"90th_percentile":4966.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5634.52,"10th_percentile":5634.52,"90th_percentile":5634.52,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8434.65,"maximum":15980.11,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15980.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11736.97},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10014.68},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9011.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8434.65},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9963.88},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8877.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12428.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11205.55},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8877.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9321.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15092.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11746.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8877.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8877.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11737.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8877.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8829.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8877.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8877.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":34948.04,"maximum":63254.38,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63254.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54049.44},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":46118.2},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35668.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":38842.04},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45884.24},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35141.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49197.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51602.22},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35141.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36898.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59740.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54091.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35738.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35141.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35141.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54054.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":35141.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34948.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":35141.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35141.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9553.62,"maximum":18475.69,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18475.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13294.05},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11343.27},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10418.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9553.62},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11285.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10264.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14369.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12692.13},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10264.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10777.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17449.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13304.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10438.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10264.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10264.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13295.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10264.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10207.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10264.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10264.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11374.86,"maximum":21671.6,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21671.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15828.34},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13505.68},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12220.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11374.86},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13437.16},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16855.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15111.67},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12039.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12641.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20467.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15840.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12244.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15829.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12039.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11973.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12039.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10547.25,"maximum":19875.06,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19875.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14676.7},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12523.03},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11207.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10547.25},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12459.5},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11041.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15458.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14012.18},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11041.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11593.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18770.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14688.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11229.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11041.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11041.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14677.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11041.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10980.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11041.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11041.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17076.24,"maximum":30907.22,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30907.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25168.47},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21475.24},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17428.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18087.05},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21366.29},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17170.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24038.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24028.91},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17170.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29190.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25188.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17462.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17170.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17170.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25170.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17170.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17076.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17170.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17170.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":7265.5,"10th_percentile":7265.5,"90th_percentile":7265.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":166835.7,"10th_percentile":166835.7,"90th_percentile":166835.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":22906.53,"10th_percentile":22906.53,"90th_percentile":22906.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16455.94,"10th_percentile":16346.4,"90th_percentile":16505.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8716.05,"maximum":16206.5,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16206.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12128.55},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10348.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9138.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8716.05},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10296.3},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12605.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11579.4},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9003.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9453.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15306.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12138.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9156.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12129.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9003.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8954.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9003.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7375.11,"10th_percentile":7375.11,"90th_percentile":7375.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7984.73,"maximum":16771.81,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16771.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11110.91},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9480.49},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9457.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7984.73},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9432.39},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13044.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10607.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9317.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9783.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15840.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11119.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9476.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11111.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9317.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9266.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9317.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":1809.84,"10th_percentile":1809.84,"90th_percentile":1809.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":3528.0,"10th_percentile":3528.0,"90th_percentile":3528.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10848.91,"10th_percentile":8299.91,"90th_percentile":13196.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":12760.6,"10th_percentile":12760.6,"90th_percentile":12760.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":1123.0,"10th_percentile":1123.0,"90th_percentile":1123.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":8410.49,"10th_percentile":8410.49,"90th_percentile":8410.49,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":3312.87,"10th_percentile":3312.87,"90th_percentile":3312.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":16792.85,"10th_percentile":8045.31,"90th_percentile":32000.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7667.73,"10th_percentile":7667.73,"90th_percentile":7667.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6326.54,"10th_percentile":6326.54,"90th_percentile":6326.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14176.73,"maximum":25659.23,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25659.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20570.02},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17551.56},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14468.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14782.42},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17462.52},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14255.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19957.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19638.66},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14255.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14967.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24233.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20586.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14497.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14255.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14255.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20571.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14255.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14176.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14255.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14255.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":16983.2,"10th_percentile":12406.88,"90th_percentile":19045.76,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":17551.56,"10th_percentile":17551.56,"90th_percentile":17551.56,"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":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13668.73,"10th_percentile":13668.73,"90th_percentile":13668.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":19862.33,"10th_percentile":19524.7,"90th_percentile":42887.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":17781.28,"10th_percentile":17781.28,"90th_percentile":17781.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":22565.61,"10th_percentile":22565.61,"90th_percentile":22565.61,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":21895.6,"10th_percentile":21895.6,"90th_percentile":21895.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":12982.86,"10th_percentile":12982.86,"90th_percentile":12982.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13685.2,"10th_percentile":13685.2,"90th_percentile":13685.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":29495.0,"maximum":53384.62,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53384.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46013.41},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":39261.38},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30102.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":33067.03},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39062.2},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29658.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41521.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43930.04},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29658.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31141.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50418.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46049.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30162.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29658.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29658.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46017.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":29658.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29495.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":29658.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29658.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":40703.13,"10th_percentile":40703.13,"90th_percentile":40703.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7341.4,"maximum":13902.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13902.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10215.7},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8716.65},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7839.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7341.4},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8672.43},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10813.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9753.16},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7723.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8110.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13130.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10223.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7855.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10216.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7723.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7681.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7723.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7126.6,"10th_percentile":7126.6,"90th_percentile":9651.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9701.1,"10th_percentile":9701.1,"90th_percentile":10284.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4442.86,"10th_percentile":4442.86,"90th_percentile":7086.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":5273.02,"10th_percentile":5273.02,"90th_percentile":5273.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8100.42,"10th_percentile":8100.42,"90th_percentile":8100.42,"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":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":5237.35,"10th_percentile":5237.35,"90th_percentile":5237.35,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":9901.22,"10th_percentile":9901.22,"90th_percentile":9997.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6495.66,"10th_percentile":6495.66,"90th_percentile":8799.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7347.21,"10th_percentile":932.23,"90th_percentile":7347.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":24970.91,"maximum":45196.22,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45196.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36734.49},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":31344.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25485.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":26398.84},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31185.04},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25109.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35152.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35071.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25109.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26364.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42685.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36763.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25535.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25109.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25109.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36737.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25109.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24970.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":25109.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25109.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9267.24,"maximum":17738.26,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17738.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12895.54},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11003.24},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10002.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9267.24},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10947.42},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9854.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13796.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12311.66},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9854.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10347.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16752.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12905.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10022.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9854.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9854.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12896.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9854.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9800.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9854.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9854.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":57148.63,"maximum":103436.44,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103436.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":86213.2},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":73562.23},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58326.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":61956.17},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73189.04},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80450.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82309.68},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60337.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97689.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86280.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58441.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86220.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":57464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57148.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":57464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57464.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":22521.97,"maximum":40763.75,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40763.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34491.29},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":29430.02},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22986.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24786.79},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29280.72},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22646.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31705.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32929.61},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22646.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23778.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38499.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34518.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23031.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22646.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22646.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34494.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22646.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22521.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":22646.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22646.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":30822.94,"10th_percentile":30822.94,"90th_percentile":30822.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":16556.28,"10th_percentile":16556.28,"90th_percentile":16556.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13434.29,"maximum":24315.46,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24315.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19821.52},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16912.9},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13711.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14244.52},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16827.1},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13508.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18912.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18924.05},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13508.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14184.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22964.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19836.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13738.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13508.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13508.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19823.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13508.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13434.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13508.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13508.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13272.52,"10th_percentile":13272.52,"90th_percentile":13272.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13244.58,"10th_percentile":13244.58,"90th_percentile":13244.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":102729.66,"maximum":185936.04,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":185936.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":163205.23},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":139256.41},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":104847.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":117285.66},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":138549.95},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103297.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144616.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":155815.71},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103297.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":175606.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163332.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105053.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103297.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103297.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163219.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":103297.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102729.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":103297.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103297.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":187653.74,"10th_percentile":187653.74,"90th_percentile":187653.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":98755.25,"10th_percentile":98755.25,"90th_percentile":98755.25,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":202033.43,"10th_percentile":202033.43,"90th_percentile":202033.43,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":99023.83,"10th_percentile":99023.83,"90th_percentile":99023.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":21995.99,"maximum":40708.15,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40708.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30607.84},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":26116.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22954.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21995.99},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25983.94},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22615.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31661.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29221.99},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22615.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23746.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38446.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30631.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23000.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22615.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22615.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30610.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22615.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22491.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":22615.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22615.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":24653.46,"maximum":44621.64,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40779.65},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":34795.62},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25161.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29305.85},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34619.1},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24789.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34705.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38933.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24789.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26029.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42142.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40811.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25211.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24789.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24789.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40783.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24789.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24653.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":24789.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24789.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17469.04,"maximum":31618.17,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31618.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25703.29},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21931.57},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17829.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18471.39},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21820.31},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17565.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24591.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24539.51},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17565.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18443.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29861.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25723.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17864.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17565.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17565.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25705.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17565.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17469.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17565.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17565.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":25523.01,"10th_percentile":25523.01,"90th_percentile":25523.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13280.68,"maximum":24037.43,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24037.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18609.82},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15879.0},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13554.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13373.74},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15798.45},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13354.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18695.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17767.21},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13354.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14021.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18624.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13581.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13354.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13354.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18611.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13354.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13280.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13354.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13354.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":2426.0,"10th_percentile":2426.0,"90th_percentile":2426.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13184.98,"10th_percentile":13184.98,"90th_percentile":13184.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11798.57,"10th_percentile":11798.57,"90th_percentile":11798.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8869.98,"maximum":16054.25,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16054.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12600.99},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10751.91},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9052.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9055.56},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10697.37},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8919.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12486.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12030.45},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8919.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9364.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15162.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12610.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8919.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8919.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12602.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8919.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8869.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8919.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8919.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":119.0,"10th_percentile":119.0,"90th_percentile":119.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11660.41,"maximum":21140.73,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21140.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16225.69},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13844.72},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11921.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11660.41},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13774.49},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11744.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16442.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15491.03},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11744.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19966.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16238.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11944.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11744.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11744.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16227.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11744.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11680.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11744.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11744.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10997.99,"10th_percentile":10997.99,"90th_percentile":10997.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8747.59,"maximum":16138.98,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16138.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12172.44},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10386.25},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9100.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8747.59},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10333.56},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12552.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11621.31},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9414.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15242.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12181.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9118.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12173.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8916.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8105.6,"10th_percentile":8105.6,"90th_percentile":8105.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4859.88,"10th_percentile":4859.88,"90th_percentile":4859.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":14967.01,"10th_percentile":14967.01,"90th_percentile":14967.01,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":252.53,"10th_percentile":252.53,"90th_percentile":252.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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","minimum":5534.28,"maximum":7707.05,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7701.05},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6571.0},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5534.28},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6537.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7352.37},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7707.05},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7701.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7338.08,"maximum":14665.46,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14665.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10211.08},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8712.7},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8269.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7338.08},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8668.5},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8147.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11406.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9748.75},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8147.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8554.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13850.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10219.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8285.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8147.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8147.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10211.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8147.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8147.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8147.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":19897.5,"maximum":36701.98,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36701.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27687.75},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":23624.83},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20695.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19897.5},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23504.98},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20389.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28545.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26434.12},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20389.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21409.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34662.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27709.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20736.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20389.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20389.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27690.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20389.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20277.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":20389.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20389.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7057.51,"maximum":13627.51,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13627.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9820.66},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8379.57},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7684.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7057.51},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8337.06},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7570.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10599.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9376.01},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7570.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12870.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9828.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7699.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7570.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7570.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9821.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7570.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7529.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7570.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7570.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":4996.82,"10th_percentile":4996.82,"90th_percentile":4996.82,"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":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7138.63,"10th_percentile":7138.63,"90th_percentile":7138.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10646.77,"10th_percentile":10646.77,"90th_percentile":10646.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":6893.82,"10th_percentile":6893.82,"90th_percentile":6893.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6249.44,"10th_percentile":6249.44,"90th_percentile":6249.44,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":9748.58,"10th_percentile":4644.77,"90th_percentile":18242.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3768.87,"10th_percentile":3768.87,"90th_percentile":3768.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6252.24,"10th_percentile":6252.24,"90th_percentile":6252.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6667.36,"maximum":13128.41,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13128.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9277.76},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7916.34},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7402.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6667.36},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7876.18},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7293.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10210.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8857.69},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7293.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7658.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12399.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7417.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7293.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7293.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9278.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7293.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7253.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7293.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7293.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":7296.5,"10th_percentile":7296.5,"90th_percentile":7296.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":28751.83,"maximum":52039.51,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52039.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44482.9},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":37955.46},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29344.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":31967.15},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37762.91},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28910.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40475.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42468.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28910.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30356.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49148.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44517.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29402.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28910.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28910.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44486.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28910.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28751.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":28910.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28910.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26628.43,"10th_percentile":26628.43,"90th_percentile":26628.43,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":40171.41,"10th_percentile":40171.41,"90th_percentile":40171.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":26940.75,"10th_percentile":26940.75,"90th_percentile":26940.75,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6389.28,"maximum":12551.18,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12551.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8890.8},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7586.16},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7077.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6389.28},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7547.68},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9762.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8488.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7321.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11853.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8897.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7091.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8891.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6934.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6972.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":17394.39,"10th_percentile":17394.39,"90th_percentile":17394.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8333.37,"maximum":15650.46,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15650.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11596.05},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9894.44},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8825.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8333.37},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9844.24},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8694.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12172.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11071.01},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8694.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9129.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14780.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11605.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8842.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8694.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8694.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11597.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8694.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8646.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8694.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8694.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8463.34,"10th_percentile":8463.34,"90th_percentile":8463.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5169.86,"maximum":10876.43,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10876.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7193.96},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6138.32},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6133.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5169.86},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6107.18},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6042.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8459.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6868.24},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6042.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10272.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7199.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6145.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6042.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6042.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7194.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6042.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6042.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6042.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5514.03,"10th_percentile":5514.03,"90th_percentile":5514.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":32611.03,"maximum":59024.48,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59024.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48849.18},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":41681.02},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33283.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":35104.93},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41469.57},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32791.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45907.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46637.41},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32791.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34430.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55745.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48887.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33348.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32791.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32791.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48853.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32791.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32611.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":32791.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32791.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6646.61,"maximum":13108.55,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13108.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9248.89},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7891.7},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7391.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6646.61},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7851.66},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7282.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10195.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8830.12},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7282.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7646.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12380.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9256.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7282.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7282.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9249.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7282.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7242.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7282.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7282.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5581.59,"maximum":11705.2,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11705.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7766.89},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6627.17},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6600.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5581.59},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6593.55},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6502.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9104.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7415.23},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6502.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6828.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11054.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7772.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6613.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6502.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6502.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7767.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6502.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6467.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6502.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6502.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5779.99,"maximum":11425.86,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11425.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8042.96},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6862.73},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6442.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5779.99},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6827.92},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8886.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7678.8},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6347.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6665.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10791.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8049.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6455.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8043.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6347.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6312.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6347.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7548.36,"10th_percentile":7548.36,"90th_percentile":7548.36,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":4395.15,"10th_percentile":4395.15,"90th_percentile":4395.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1235.51,"10th_percentile":1235.51,"90th_percentile":1235.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":6357.7,"10th_percentile":6357.7,"90th_percentile":6357.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":72969.42,"maximum":132071.35,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132071.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":111471.77},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":95114.34},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74473.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":80107.97},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":94631.82},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73372.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102722.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106424.61},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73372.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77041.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124734.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111558.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74620.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73372.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73372.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111481.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":73372.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72969.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":73372.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73372.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":63073.48,"maximum":114160.14,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114160.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":97876.24},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":83513.83},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64373.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":70337.69},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83090.16},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63422.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88791.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93444.66},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63422.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66593.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107817.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97952.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64500.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63422.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63422.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97884.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":63422.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63073.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":63422.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63422.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11538.35,"maximum":20883.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20883.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17439.7},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14880.59},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11776.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12532.85},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14805.1},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16243.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16650.07},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11602.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12182.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19723.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17453.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11799.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17441.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11602.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11538.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11602.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":20397.81,"maximum":36919.12,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36919.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29488.55},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":25161.38},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20818.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21191.62},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25033.74},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20510.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28714.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28153.38},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20510.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21536.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34868.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29511.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20859.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20510.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20510.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29491.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20510.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20397.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":20510.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20510.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":12109.02,"10th_percentile":12109.02,"90th_percentile":12109.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17317.11,"10th_percentile":17317.11,"90th_percentile":17317.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15240.27,"maximum":27584.21,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27584.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21916.87},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18700.77},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15554.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15750.32},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18605.9},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15324.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21454.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20924.53},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15324.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16090.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26051.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21933.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15585.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15324.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15324.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21918.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15324.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15324.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15324.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":32303.08,"maximum":58467.11,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58467.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48056.78},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":41004.9},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32968.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":34535.48},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40796.88},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32481.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45474.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45880.89},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32481.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34105.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55218.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48094.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33033.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32481.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32481.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48060.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32481.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32303.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":32481.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32481.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":65610.25,"10th_percentile":65610.25,"90th_percentile":65610.25,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8643.46,"10th_percentile":8643.46,"90th_percentile":8643.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":35194.55,"maximum":63700.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63700.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53737.56},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":45852.08},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35920.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":38617.91},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45619.47},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35389.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49544.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51304.46},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35389.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37158.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60161.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53779.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35990.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35389.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35389.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53742.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":35389.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35194.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":35389.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35389.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":4659.35,"maximum":10484.55,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10484.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":6483.58},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":5532.17},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5912.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4659.35},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5504.11},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5824.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8154.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6190.02},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5824.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9902.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6488.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5824.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5824.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6484.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5824.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5792.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":5824.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5824.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":4557.25,"maximum":10048.99,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10048.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":6341.5},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":5410.94},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5666.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4557.25},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5383.49},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5582.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7815.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6054.37},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5582.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5861.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9490.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6346.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5677.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5582.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5582.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6342.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5582.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5552.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":5582.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5582.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5921.1,"maximum":12083.83,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12083.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8239.33},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7030.28},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6813.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5921.1},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6994.62},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6713.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9398.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7866.27},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6713.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11412.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8245.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6713.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6713.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8240.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6713.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6713.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6713.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6136.93,"maximum":12295.66,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8539.65},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7286.54},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6933.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6136.93},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7249.58},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9563.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8153.0},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6830.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7172.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11612.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8546.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6947.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8540.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6830.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6793.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6830.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":6408.84,"10th_percentile":6357.45,"90th_percentile":8539.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":5833.88,"10th_percentile":5833.88,"90th_percentile":5833.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10072.7,"10th_percentile":10072.7,"90th_percentile":10072.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":5300.57,"10th_percentile":5300.57,"90th_percentile":5300.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":8540.39,"10th_percentile":8540.39,"90th_percentile":8540.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6322.73,"10th_percentile":4757.88,"90th_percentile":6766.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":50321.17,"maximum":91079.05,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91079.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":71454.49},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":60969.22},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51358.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":51349.99},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60659.92},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70839.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68219.21},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53129.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86019.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71510.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51459.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71460.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":50599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50321.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":50599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50599.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":37892.91,"maximum":68584.45,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68584.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58664.06},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":50055.67},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38674.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":42158.29},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49801.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38102.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53343.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56007.9},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38102.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40007.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64774.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58709.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38750.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38102.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38102.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58669.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":38102.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37892.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":38102.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38102.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37370.47,"10th_percentile":37370.47,"90th_percentile":37370.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13392.6,"maximum":24240.01,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24240.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19156.18},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16345.19},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13668.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13766.38},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16262.27},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18853.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18288.84},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13466.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14140.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22893.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19171.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13695.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19157.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13466.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13392.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13466.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10449.3,"maximum":19883.0,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19883.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14540.4},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12406.73},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11211.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10449.3},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12343.79},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11046.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15464.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13882.05},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11046.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11598.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18778.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14551.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11233.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11046.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11046.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14541.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11046.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10985.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11046.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11046.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":33543.64,"maximum":60712.47,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60712.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49269.64},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":42039.78},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34235.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":35407.09},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41826.51},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33729.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47220.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47038.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33729.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35415.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57339.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49308.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34302.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33729.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33729.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49273.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":33729.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33543.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":33729.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33729.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":45603.28,"10th_percentile":45603.28,"90th_percentile":45603.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6020.72,"maximum":12185.78,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12185.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8377.94},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7148.56},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6871.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6020.72},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7112.29},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6769.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9477.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7998.61},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6769.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7108.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11508.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8384.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6884.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6769.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6769.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8378.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6769.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6732.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6769.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6769.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9040.62,"maximum":16900.24,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16900.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12580.19},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10734.17},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9529.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9040.62},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10679.71},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13144.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12010.59},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9389.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9858.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15961.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12590.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9548.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12581.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9389.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9337.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9389.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":12021.98,"10th_percentile":12021.98,"90th_percentile":12021.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6654.91,"maximum":13011.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13011.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9260.44},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7901.56},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7337.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6654.91},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7861.47},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7228.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10120.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8841.15},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7228.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7590.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12289.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9267.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7228.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7228.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9261.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7228.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7189.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7228.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7228.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8431.0,"10th_percentile":8431.0,"90th_percentile":8431.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":36.65,"10th_percentile":36.65,"90th_percentile":36.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":11702.93,"10th_percentile":11702.93,"90th_percentile":11702.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":3430.68,"10th_percentile":3430.68,"90th_percentile":3430.68,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6762.0,"10th_percentile":6744.76,"90th_percentile":7097.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12483.39,"maximum":22594.37,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22594.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17480.13},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14915.08},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12740.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12561.9},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14839.42},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12552.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17573.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16688.67},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12552.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13180.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21339.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17493.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12765.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12552.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12552.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17481.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12552.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12552.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12552.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":17346.48,"10th_percentile":17346.48,"90th_percentile":17346.48,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":707.0,"10th_percentile":707.0,"90th_percentile":707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11691.41,"10th_percentile":11691.41,"90th_percentile":11691.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12874.85,"maximum":23575.39,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23575.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17915.6},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15286.66},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13293.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12874.85},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15209.11},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13097.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18336.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17104.43},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13097.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13752.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22265.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17929.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13320.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13097.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13097.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17917.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13097.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13025.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13097.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13097.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13767.21,"maximum":24950.93,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24950.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19157.33},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16346.18},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14069.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13767.21},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16263.25},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19406.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18289.94},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14554.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23564.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19172.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14097.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19158.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13785.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13861.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":17785.82,"10th_percentile":15636.51,"90th_percentile":17970.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11192.1,"10th_percentile":11192.1,"90th_percentile":11192.1,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":11829.08,"10th_percentile":11829.08,"90th_percentile":11829.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":15812.56,"10th_percentile":15812.56,"90th_percentile":15812.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":18288.84,"10th_percentile":18288.84,"90th_percentile":18288.84,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":19025.09,"10th_percentile":19025.09,"90th_percentile":19157.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1709.76,"10th_percentile":1709.76,"90th_percentile":1709.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12832.06,"10th_percentile":12832.06,"90th_percentile":12832.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12873.8,"10th_percentile":12873.8,"90th_percentile":12873.8,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":82027.84,"maximum":148466.68,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":148466.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":121072.96},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":103306.65},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83718.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":87007.76},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":102782.57},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82481.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115474.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115591.08},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82481.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86605.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140218.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121167.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83883.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82481.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82481.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121083.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":82481.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82027.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":82481.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82481.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":72454.66,"10th_percentile":72454.66,"90th_percentile":73712.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":89169.25,"10th_percentile":89169.25,"90th_percentile":89169.25,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":163554.66,"10th_percentile":163554.66,"90th_percentile":163554.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":18440.34,"10th_percentile":18440.34,"90th_percentile":18440.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":74786.24,"10th_percentile":74786.24,"90th_percentile":75143.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14846.75,"maximum":26871.95,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26871.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21074.8},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17982.27},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15152.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15145.17},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17891.05},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14928.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20900.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20120.59},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14928.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15675.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25379.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21091.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15182.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14928.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14928.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21076.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14928.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14928.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14928.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":15783.69,"10th_percentile":15783.69,"90th_percentile":15783.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5832.28,"maximum":11819.05,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11819.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8115.73},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6924.83},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6664.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5832.28},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6889.7},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6566.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9192.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7748.27},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6566.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11162.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8122.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6677.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6566.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6566.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8116.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6566.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6566.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6566.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":62879.64,"maximum":113809.3,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113809.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":97820.8},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":83466.52},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64175.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":70297.85},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83043.09},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63227.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88518.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93391.72},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63227.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66388.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107486.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97897.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64302.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63227.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63227.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97829.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":63227.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62879.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":63227.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63227.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":39487.5,"maximum":71470.58,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71470.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58844.26},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":50209.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40301.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":42287.78},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49954.71},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39705.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55588.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56179.94},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39705.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41691.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67500.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58890.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40380.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39705.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39705.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58849.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":39705.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39487.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":39705.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39705.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39250.71,"10th_percentile":39250.71,"90th_percentile":39250.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":97292.05,"10th_percentile":97292.05,"90th_percentile":97292.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":32812.91,"maximum":59389.88,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59389.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51799.3},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":44198.25},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33489.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":37225.0},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43974.03},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32994.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46192.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49453.96},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32994.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34644.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56090.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51839.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33555.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32994.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32994.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51803.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32994.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32812.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":32994.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32994.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":23518.58,"10th_percentile":23518.58,"90th_percentile":23518.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13168.71,"maximum":24148.66,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24148.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18324.51},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15635.56},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13168.71},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15556.24},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18782.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17494.82},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13415.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14086.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22807.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18338.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13643.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18326.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13415.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13342.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13415.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":19961.42,"10th_percentile":19961.42,"90th_percentile":19961.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":19324.25,"10th_percentile":19324.25,"90th_percentile":19324.25,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","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":211.25,"10th_percentile":211.25,"90th_percentile":211.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12205.61,"10th_percentile":10943.01,"90th_percentile":12295.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":19930.7,"maximum":36131.38,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36131.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27733.95},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":23664.26},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20374.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19930.7},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23544.21},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20072.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28102.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26478.23},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20072.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21076.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34124.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27755.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20414.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20072.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20072.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27736.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20072.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19962.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":20072.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20072.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":30039.09,"10th_percentile":30039.09,"90th_percentile":30039.09,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17916.01,"10th_percentile":17916.01,"90th_percentile":17916.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17882.49,"10th_percentile":14990.15,"90th_percentile":18165.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14198.68,"maximum":25698.96,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25698.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20617.38},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17591.97},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14491.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14816.45},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17502.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14277.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19988.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19683.88},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14277.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14991.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24271.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20633.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14519.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14277.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14277.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20619.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14277.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14198.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14277.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14277.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":28953.75,"10th_percentile":28953.75,"90th_percentile":28953.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9755.31,"10th_percentile":9755.31,"90th_percentile":9755.31,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13693.54,"10th_percentile":13693.54,"90th_percentile":35080.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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","minimum":14580.71,"maximum":20305.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20289.33},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17312.06},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14580.71},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17224.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19370.68},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20305.14},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20291.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12390.07,"maximum":22900.19,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22900.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17241.02},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14711.07},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12913.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12390.07},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14636.44},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12722.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17811.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16460.39},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12722.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13358.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21627.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17254.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12722.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12722.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17242.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12722.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12652.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12722.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12722.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":30163.79,"10th_percentile":30163.79,"90th_percentile":30163.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":13789.37,"10th_percentile":13789.37,"90th_percentile":13789.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":19871.07,"10th_percentile":19871.07,"90th_percentile":19871.07,"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":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2398.98,"10th_percentile":2398.98,"90th_percentile":2398.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10948.52,"10th_percentile":10913.95,"90th_percentile":11798.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10789.33,"maximum":19528.2,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19528.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15361.67},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13107.49},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11011.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11039.5},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13041.0},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10849.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15188.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14666.14},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10849.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18443.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15373.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11033.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10849.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10849.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15363.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10849.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10789.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10849.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10849.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10769.4,"10th_percentile":10769.4,"90th_percentile":10769.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8805.7,"maximum":16165.46,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16165.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12253.3},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10455.24},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9115.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8805.7},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10402.2},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12573.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11698.5},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8980.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9429.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15267.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12262.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9133.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12254.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8980.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8931.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8980.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6405.58,"10th_percentile":6405.58,"90th_percentile":6526.36,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8573.24,"10th_percentile":7606.34,"90th_percentile":8831.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13672.02,"maximum":24745.73,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24745.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19709.47},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16817.29},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13953.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14164.0},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16731.98},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13747.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19246.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18817.08},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13747.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14435.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23370.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19724.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13981.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13747.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13747.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19711.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13747.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13672.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13747.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13747.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13511.37,"10th_percentile":13511.37,"90th_percentile":13511.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6015.32,"10th_percentile":6015.32,"90th_percentile":6015.32,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13064.43,"10th_percentile":12895.39,"90th_percentile":13732.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15053.02,"maximum":27245.29,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27245.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21439.81},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18293.72},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15363.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15407.49},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18200.92},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21190.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20469.07},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15136.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15893.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25731.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21456.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15393.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21441.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15136.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15053.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15136.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":22925.01,"maximum":41493.22,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41493.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34773.13},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":29670.5},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23397.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24989.33},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29519.98},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23051.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32272.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33198.69},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23051.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24204.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39188.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34800.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23443.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23051.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23051.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34776.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23051.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22925.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":23051.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23051.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13162.19,"maximum":23822.96,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23822.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19524.66},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16659.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13433.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14031.18},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16575.08},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18528.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18640.63},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13234.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13896.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22499.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19539.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13459.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19526.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13234.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13162.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13234.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15567.96,"maximum":28177.31,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28177.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23751.17},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":20265.91},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15888.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17068.52},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20163.1},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15654.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21915.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22675.77},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15654.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16436.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26611.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23769.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15920.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15654.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15654.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23753.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15654.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15567.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15654.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15654.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9253.1,"10th_percentile":9253.1,"90th_percentile":9253.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7945.72,"maximum":16345.51,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16345.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11056.62},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9434.16},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9217.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7945.72},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9386.3},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9080.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12713.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10556.0},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9080.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9534.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15437.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11065.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9235.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9080.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9080.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11057.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9080.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9030.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9080.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9080.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17444.17,"maximum":31573.15,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31573.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26322.42},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22459.85},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17803.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18916.32},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22345.91},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24556.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25130.61},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17540.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18417.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29819.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26342.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17838.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26324.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17540.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17444.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17540.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":27446.17,"maximum":49676.33,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49676.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43246.94},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":36900.86},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28011.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":31078.94},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36713.66},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27597.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38637.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41288.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27597.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28977.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46916.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43280.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28067.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27597.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27597.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43250.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27597.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27446.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":27597.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27597.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":13903.36,"10th_percentile":13903.36,"90th_percentile":13903.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11631.36,"maximum":21878.14,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21878.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16185.26},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13810.23},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12336.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11631.36},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13740.17},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17016.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15452.43},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12154.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12762.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20662.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16197.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12361.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16186.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12154.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12087.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12154.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8579.08,"maximum":16125.75,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16125.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11937.96},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10186.18},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9093.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8579.08},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10134.5},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8958.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12542.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11397.44},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8958.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15229.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11947.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9111.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8958.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8958.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11938.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8958.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8909.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8958.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8958.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8318.88,"10th_percentile":5908.74,"90th_percentile":8498.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":24700.27,"maximum":44706.37,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44706.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37629.69},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":32107.89},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25209.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":27042.17},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31945.01},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24836.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34771.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35925.92},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24836.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26078.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42222.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37659.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25259.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24836.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24836.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37632.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24836.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24700.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":24836.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24836.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8963.42,"maximum":16415.68,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16415.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12472.77},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10642.51},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9256.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8963.42},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10588.52},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9119.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12767.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11908.03},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9119.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9575.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15503.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12482.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9274.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9119.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9119.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12473.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9119.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9069.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9119.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9119.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8903.29,"10th_percentile":8903.29,"90th_percentile":8903.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9083.78,"maximum":16847.28,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16847.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12640.26},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10785.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9499.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9083.78},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10730.71},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9359.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13103.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12067.94},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9359.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9827.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15911.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12650.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9518.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9359.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9359.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12641.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9359.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9359.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9359.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8737.63,"maximum":16427.59,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16427.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12158.58},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10374.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9263.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8737.63},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10321.8},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9126.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12777.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11608.07},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9126.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9582.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15514.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12168.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9281.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9126.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9126.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12159.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9126.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9126.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9126.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8315.94,"maximum":16824.76,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16824.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11571.79},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9873.74},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9487.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8315.94},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9823.65},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13085.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11047.85},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9347.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9814.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15890.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11580.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11572.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9347.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9295.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9347.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15859.89,"maximum":30143.32,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30143.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22069.34},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18830.87},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16997.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15859.89},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18735.34},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16746.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23444.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21070.1},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16746.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17583.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28468.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22086.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17030.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16746.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16746.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22071.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16746.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16654.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16746.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16746.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14350.77,"maximum":26514.49,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26514.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19969.37},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17039.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14951.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14350.77},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16952.61},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20622.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19065.21},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15466.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25041.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19984.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14980.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19971.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14649.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14730.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5037.88,"maximum":11452.34,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11452.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7010.3},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":5981.61},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6457.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5037.88},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5951.26},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6362.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8907.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6692.89},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6362.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10816.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7015.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6362.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6362.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7010.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6362.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6327.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6362.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6362.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11401.42,"maximum":21435.95,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21435.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15865.3},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13537.22},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12087.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11401.42},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13468.54},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16672.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15146.96},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11908.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20245.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15877.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12111.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15866.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11908.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11843.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11908.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":20193.0,"maximum":36548.42,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36548.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29898.61},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":25511.27},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20609.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21486.31},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25381.85},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20304.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28426.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28544.88},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20304.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21319.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34517.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29921.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20649.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20304.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20304.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29901.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20304.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20193.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":20304.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20304.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8180.64,"maximum":15894.05,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15894.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11383.51},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9713.09},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8962.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8180.64},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9663.81},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12362.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10868.09},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8830.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9271.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15011.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11392.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11384.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8830.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8781.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8830.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8989.98,"maximum":16590.44,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16590.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12509.73},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10674.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9355.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8989.98},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10619.9},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12903.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11943.32},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9216.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9677.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15668.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12519.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12510.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9216.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9166.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9216.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":19326.94,"maximum":34980.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34980.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28297.64},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":24145.23},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19725.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20335.79},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24022.74},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19433.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27207.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27016.39},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19433.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20405.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33037.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28319.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19764.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19433.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19433.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28300.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19433.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19326.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19433.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19433.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"14","median_amount":2046.0,"10th_percentile":960.0,"90th_percentile":4092.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":1600.0,"10th_percentile":1600.0,"90th_percentile":3374.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":12259.17,"10th_percentile":12259.17,"90th_percentile":12259.17},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4828.49,"10th_percentile":2414.25,"90th_percentile":12071.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":7720.35,"10th_percentile":7720.35,"90th_percentile":7720.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":2690.0,"10th_percentile":2690.0,"90th_percentile":2690.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":3922.0,"10th_percentile":1824.96,"90th_percentile":15098.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4797.96,"10th_percentile":2398.98,"90th_percentile":4797.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":21961.67,"maximum":39749.63,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39749.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33654.99},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":28716.44},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22414.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24185.79},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28570.76},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22083.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30916.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32131.18},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22083.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23187.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37541.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33681.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22458.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22083.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22083.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33657.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22083.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21961.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":22083.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22083.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17561.94,"maximum":31786.31,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31786.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26456.41},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22574.18},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17923.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19012.61},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22459.66},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17659.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24722.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25258.53},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17659.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18542.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30020.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26477.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17659.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17659.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26458.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17659.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17561.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17659.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17659.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17128.4,"10th_percentile":17128.4,"90th_percentile":17128.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5473.68,"maximum":10922.76,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10922.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7616.73},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6499.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6159.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5473.68},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6466.08},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8495.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7271.86},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6068.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6371.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10315.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7622.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6171.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7617.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6068.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6034.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6068.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17983.98,"maximum":32550.19,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32550.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25404.11},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21676.3},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18354.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18256.39},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21566.34},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25316.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24253.88},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18083.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18987.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30741.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25423.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25406.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18083.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17983.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18083.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6203.34,"maximum":12109.0,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12109.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8632.06},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7365.39},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6828.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6203.34},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7328.02},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6727.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9418.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8241.22},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6727.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11436.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8638.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6841.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6727.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6727.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8632.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6727.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6690.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6727.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6727.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8444.56,"10th_percentile":8444.56,"90th_percentile":8444.56,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":3461.72,"10th_percentile":3461.72,"90th_percentile":3461.72,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10830.64,"10th_percentile":10830.64,"90th_percentile":10830.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8588.07,"10th_percentile":8588.07,"90th_percentile":8588.07,"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":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":10580.69,"10th_percentile":10580.69,"90th_percentile":10580.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":5563.21,"10th_percentile":5563.21,"90th_percentile":5563.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5716.64,"10th_percentile":5716.64,"90th_percentile":5716.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":25074.04,"maximum":45382.88,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45382.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36840.76},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":31434.73},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25590.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":26475.21},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31275.26},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25212.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35297.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35172.7},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25212.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26473.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42861.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36869.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25212.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25212.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36843.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25212.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25074.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":25212.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25212.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23571.2,"10th_percentile":23571.2,"90th_percentile":23571.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48194.89,"10th_percentile":48194.89,"90th_percentile":48194.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6797.69,"maximum":13800.96,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13800.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9459.11},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8071.08},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7782.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6797.69},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8030.13},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7667.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10734.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9030.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7667.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8050.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13034.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9466.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7797.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7667.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7667.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9459.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7667.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7625.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7667.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7667.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10695.01,"maximum":20996.42,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20996.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14882.31},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12698.47},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11839.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10695.01},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12634.05},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11664.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16330.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14208.48},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11664.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12247.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19829.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14893.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11862.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11664.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11664.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14883.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11664.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11664.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11664.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5972.57,"maximum":12216.22,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12216.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8310.94},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7091.39},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6888.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5972.57},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7055.42},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6786.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9501.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7934.65},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6786.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7126.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11537.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8317.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6902.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6786.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6786.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8311.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6786.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6749.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6786.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6786.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":119.0,"10th_percentile":119.0,"90th_percentile":119.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15409.98,"maximum":28587.73,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28587.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21443.28},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18296.68},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16120.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15409.98},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18203.86},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22234.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20472.38},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16676.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26999.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21459.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16152.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21445.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15882.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4085.81,"10th_percentile":4085.81,"90th_percentile":4085.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":14022.41,"10th_percentile":14022.41,"90th_percentile":14087.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":14595.73,"10th_percentile":14595.73,"90th_percentile":14595.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":12837.11,"10th_percentile":5855.4,"90th_percentile":12914.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12369.83,"10th_percentile":12369.83,"90th_percentile":15794.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7323.14,"maximum":14243.13,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14243.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10190.29},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8694.96},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8031.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7323.14},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8650.85},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7912.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11077.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9728.9},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7912.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13451.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10198.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8047.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7912.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7912.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10191.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7912.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7869.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7912.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7912.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":7422.03,"10th_percentile":7422.03,"90th_percentile":7422.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"20","median_amount":8547.57,"10th_percentile":3844.94,"90th_percentile":10197.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":4761.8,"10th_percentile":3757.56,"90th_percentile":9260.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7042.63,"10th_percentile":7042.63,"90th_percentile":7042.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":5988.49,"10th_percentile":5988.49,"90th_percentile":5988.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"23","median_amount":9949.34,"10th_percentile":5589.97,"90th_percentile":16408.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"17","median_amount":9193.48,"10th_percentile":4817.98,"90th_percentile":11430.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":8626.42,"10th_percentile":1239.82,"90th_percentile":9631.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":7853.7,"10th_percentile":7853.7,"90th_percentile":7853.7,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":7700.28,"10th_percentile":4334.8,"90th_percentile":12597.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"21","median_amount":9063.26,"10th_percentile":3900.5,"90th_percentile":12262.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7234.02,"10th_percentile":5385.74,"90th_percentile":7874.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7386.33,"10th_percentile":7386.33,"90th_percentile":7386.33,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16006.11,"maximum":28970.33,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28970.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23298.37},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19879.55},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16336.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16743.12},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19778.7},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16094.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22532.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22243.48},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16094.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16899.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27360.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23316.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16368.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16094.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16094.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23300.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16094.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16006.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16094.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16094.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":16399.64,"10th_percentile":16399.64,"90th_percentile":16399.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":22380.8,"10th_percentile":22380.8,"90th_percentile":22380.8},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":15099.6,"10th_percentile":15099.6,"90th_percentile":15099.6,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13360.65,"10th_percentile":13360.65,"90th_percentile":15366.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14803.59,"maximum":26793.83,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26793.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21062.09},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17971.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15108.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15136.04},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17880.26},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14885.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20839.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20108.46},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14885.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15629.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25305.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21078.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15138.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14885.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14885.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21063.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14885.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14803.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14885.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14885.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":200.0,"10th_percentile":200.0,"90th_percentile":200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":29896.57,"maximum":54111.44,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54111.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49977.71},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":42643.96},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30512.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":35915.94},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42427.62},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30061.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42086.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47714.85},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30061.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31565.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51105.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50016.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30572.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30061.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30061.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49982.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":30061.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29896.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":30061.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30061.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10675.92,"maximum":19361.38,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19361.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14855.74},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12675.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10917.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10675.92},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12611.5},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10756.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15058.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14183.11},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10756.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11294.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18285.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14867.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10939.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10756.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10756.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14857.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10756.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10697.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10756.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10756.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10203.31,"10th_percentile":10203.31,"90th_percentile":10203.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10537.29,"10th_percentile":10537.29,"90th_percentile":10537.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":1107.0,"10th_percentile":1107.0,"90th_percentile":1107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6671.89,"10th_percentile":6671.89,"90th_percentile":10123.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":32235.06,"maximum":58343.99,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58343.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47468.83},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":40503.23},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32899.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":34112.96},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40297.76},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32413.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45378.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45319.57},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32413.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34034.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55102.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47505.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32964.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32413.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32413.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47472.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32413.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32235.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":32413.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32413.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10884.41,"maximum":19700.3,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19700.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16417.44},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14008.33},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11108.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11798.21},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13937.27},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15322.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15674.1},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10944.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11491.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18605.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16430.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11130.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16418.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10944.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10884.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10944.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9590.98,"maximum":18432.0,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18432.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13346.03},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11387.62},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10393.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9590.98},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11329.85},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14336.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12741.75},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10752.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17408.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13356.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10414.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13347.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10183.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10240.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":27424.96,"maximum":49637.93,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49637.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39786.26},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":33948.01},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27990.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":28591.96},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33775.79},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27576.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38607.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37984.84},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27576.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28955.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46880.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39817.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28045.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27576.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27576.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39789.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27576.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27424.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":27576.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27576.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25430.11,"10th_percentile":25430.11,"90th_percentile":25430.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25195.59,"10th_percentile":23825.71,"90th_percentile":25455.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":26598.06,"maximum":50301.22,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50301.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37011.71},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":31580.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28364.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":26598.06},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31420.39},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27945.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39123.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35335.92},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27945.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29342.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47506.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37040.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28420.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27945.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27945.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37014.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27945.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27791.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":27945.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27945.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9044.77,"maximum":16722.83,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16722.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12585.97},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10739.1},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9429.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9044.77},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10684.62},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9290.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13006.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12016.11},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9290.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15793.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12595.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9448.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9290.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9290.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12587.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9290.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9239.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9290.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9290.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":12480.27,"10th_percentile":12480.27,"90th_percentile":12480.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8398.65,"10th_percentile":8398.65,"90th_percentile":8398.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9045.6,"10th_percentile":9045.6,"90th_percentile":9045.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10608.7,"10th_percentile":10608.7,"90th_percentile":10608.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":8807.89,"10th_percentile":8807.89,"90th_percentile":8807.89,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":12202.46,"10th_percentile":12202.46,"90th_percentile":12202.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8750.18,"10th_percentile":8750.18,"90th_percentile":8750.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","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":8491.91,"10th_percentile":8491.91,"90th_percentile":8491.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6556.13,"maximum":9130.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9122.98},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7784.27},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6556.13},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7744.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8709.91},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9130.09},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9123.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5581.59,"maximum":11468.21,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11468.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7766.89},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6627.17},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6466.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5581.59},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6593.55},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6371.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8919.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7415.23},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6371.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6689.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10831.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7772.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6479.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6371.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6371.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7767.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6371.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6336.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6371.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6371.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5834.05,"10th_percentile":5834.05,"90th_percentile":5834.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5798.25,"maximum":11848.18,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11848.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8068.37},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6884.42},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6681.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5798.25},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6849.49},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6582.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9215.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7703.06},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6582.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6911.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11189.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8074.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6694.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6582.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6582.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8069.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6582.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6546.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6582.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6582.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6231.09,"10th_percentile":6231.09,"90th_percentile":6231.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":19005.84,"maximum":34399.71,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34399.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26735.94},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22812.7},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19397.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19213.49},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22696.97},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19110.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26755.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25525.41},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19110.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20066.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26756.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19435.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19110.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19110.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26738.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19110.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19005.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19110.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19110.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13132.2,"maximum":23768.69,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23768.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18405.36},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15704.55},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13402.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13226.81},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15624.88},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13204.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18486.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17572.02},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13204.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13865.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22448.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18419.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13429.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13204.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13204.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18406.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13204.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13132.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13204.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13204.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12360.93,"10th_percentile":12360.93,"90th_percentile":12360.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16836.32,"maximum":30472.97,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30472.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24400.33},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":20819.81},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17183.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17535.03},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20714.19},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16929.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23701.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23295.55},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16929.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17775.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28780.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24419.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17217.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16929.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16929.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24402.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16929.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16929.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16929.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16744.29,"10th_percentile":16744.29,"90th_percentile":16744.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":19639.29,"maximum":35546.22,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35546.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27951.11},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":23849.55},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20044.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20086.76},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23728.56},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27647.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26685.55},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19747.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20735.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33571.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27972.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20083.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27953.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19747.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19639.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19747.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11247.86,"maximum":21062.61,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21062.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15651.61},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13354.88},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11876.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11247.86},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13287.13},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11701.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16382.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14942.94},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11701.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12286.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19892.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15663.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11701.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11701.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15652.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11701.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11637.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11701.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11701.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":15796.4,"10th_percentile":15796.4,"90th_percentile":15796.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8812.36,"10th_percentile":8812.36,"90th_percentile":8812.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10199.44,"maximum":18569.68,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18569.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14192.71},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12110.07},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10471.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10199.44},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12048.63},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14443.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13550.1},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10316.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10832.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17538.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14203.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10491.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14193.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10316.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10259.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10316.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9555.01,"10th_percentile":9555.01,"90th_percentile":9702.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10494.12,"maximum":20834.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20834.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14602.77},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12459.96},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11748.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10494.12},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12396.75},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11574.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16204.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13941.6},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11574.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12153.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19677.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14614.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11574.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11574.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14604.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11574.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11574.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11574.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10665.95,"maximum":19346.81,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19346.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14841.88},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12663.97},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10909.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10665.95},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12599.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15047.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14169.88},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10748.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11285.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18271.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14853.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10930.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14843.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10748.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10689.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10748.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":13918.84,"10th_percentile":11857.85,"90th_percentile":14826.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":12036.61,"10th_percentile":12036.61,"90th_percentile":12036.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":7330.1,"10th_percentile":7330.1,"90th_percentile":7330.1},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":13217.94,"10th_percentile":13217.94,"90th_percentile":13217.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":11565.89,"10th_percentile":11565.89,"90th_percentile":11565.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":14136.02,"10th_percentile":14136.02,"90th_percentile":14136.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":14165.47,"10th_percentile":14165.47,"90th_percentile":14165.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":10061.97,"10th_percentile":10061.97,"90th_percentile":10061.97,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":22381.9,"10th_percentile":22381.9,"90th_percentile":22381.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":7905.05,"10th_percentile":7905.05,"90th_percentile":7905.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10165.51,"10th_percentile":10154.78,"90th_percentile":10495.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":167.53,"10th_percentile":167.53,"90th_percentile":167.53,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":30820.4,"maximum":55783.53,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55783.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45386.19},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":38726.2},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31455.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":32616.29},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38529.74},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30990.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43387.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43331.22},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30990.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32540.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52684.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45421.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31517.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30990.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30990.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45390.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":30990.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30820.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":30990.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30990.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"12","median_amount":57669.24,"10th_percentile":56152.38,"90th_percentile":59660.66,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":48269.3,"10th_percentile":48269.3,"90th_percentile":48269.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28478.95,"10th_percentile":28434.01,"90th_percentile":28729.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":46492.72,"10th_percentile":46492.72,"90th_percentile":47991.97,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":18806.14,"10th_percentile":2414.25,"90th_percentile":30352.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2573.45,"10th_percentile":2573.45,"90th_percentile":2573.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":57921.6,"10th_percentile":57921.6,"90th_percentile":58565.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":62218.07,"10th_percentile":62218.07,"90th_percentile":62218.07,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":64279.41,"10th_percentile":64279.41,"90th_percentile":64279.41,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":29412.99,"10th_percentile":29412.99,"90th_percentile":30684.19,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"12","median_amount":56115.13,"10th_percentile":53573.22,"90th_percentile":59090.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4797.96,"10th_percentile":4797.96,"90th_percentile":18686.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"30","median_amount":28681.93,"10th_percentile":26798.02,"90th_percentile":30645.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28921.33,"10th_percentile":28852.5,"90th_percentile":30841.31,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16790.97,"maximum":30390.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30390.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24620.96},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21008.06},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17137.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17693.58},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20901.49},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23637.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23506.18},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16883.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28702.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24640.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17170.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24623.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16883.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16790.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16883.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":26333.62,"maximum":47662.67,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40765.79},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":34783.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26876.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29295.89},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34607.34},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37070.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38920.02},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27803.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45014.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40797.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26929.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40769.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26333.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":26479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26479.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":42534.76,"maximum":76986.0,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76986.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":63590.57},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":54259.25},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43411.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":45698.67},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53983.99},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59878.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60711.35},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44908.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72709.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63640.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43497.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63596.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":42770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42534.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":42770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42770.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":93250.57,"10th_percentile":75225.34,"90th_percentile":105318.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":81131.63,"10th_percentile":81131.63,"90th_percentile":81131.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39863.85,"10th_percentile":39863.85,"90th_percentile":39863.85,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":67772.08,"10th_percentile":67772.08,"90th_percentile":67772.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2414.25,"10th_percentile":2414.25,"90th_percentile":2414.25,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":83757.83,"10th_percentile":83757.83,"90th_percentile":83757.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":83783.25,"10th_percentile":83783.25,"90th_percentile":83783.25,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":40047.64,"10th_percentile":40047.64,"90th_percentile":40047.64,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":63471.35,"10th_percentile":63471.35,"90th_percentile":63471.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4797.96,"10th_percentile":4797.96,"90th_percentile":4797.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38877.28,"10th_percentile":38340.13,"90th_percentile":39969.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42560.88,"10th_percentile":42560.88,"90th_percentile":42560.88,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6517.12,"maximum":13852.58,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13852.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9068.69},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7737.95},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7811.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6517.12},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7698.69},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10774.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8658.08},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7695.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13083.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9075.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7826.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9069.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7695.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7653.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7695.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9001.6,"maximum":17044.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17044.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12525.9},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10687.85},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9611.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9001.6},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10633.63},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13256.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11958.76},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9469.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16097.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12535.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9630.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12526.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9469.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9417.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9469.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":2499.0,"10th_percentile":2499.0,"90th_percentile":2499.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9378.52,"10th_percentile":9378.52,"90th_percentile":9378.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6534.81,"10th_percentile":6534.81,"90th_percentile":6534.81,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8199.44,"10th_percentile":8199.44,"90th_percentile":8199.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":31932.96,"maximum":57797.21,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57797.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49873.75},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":42555.25},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32591.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":35841.23},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42339.37},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32109.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44953.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47615.6},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32109.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33715.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54586.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49912.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32655.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32109.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32109.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49878.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32109.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31932.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":32109.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32109.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":21512.56,"maximum":38936.75,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38936.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30300.58},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":25854.26},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21956.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21775.18},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25723.1},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30284.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28928.65},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22713.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36773.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30324.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21999.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30303.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21512.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":21631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21631.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":38795.5,"10th_percentile":38795.5,"90th_percentile":38795.5,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9654.06,"maximum":18180.45,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18180.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13433.81},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11462.53},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10251.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9654.06},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11404.38},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10100.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14140.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12825.56},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10100.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10605.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17170.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13444.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10271.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10100.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10100.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13434.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10100.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10100.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10100.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":25016.99,"maximum":45279.61,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45279.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37235.8},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":31771.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25532.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":26759.1},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31610.62},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25155.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35217.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35549.86},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25155.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26413.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42764.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37264.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25582.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25155.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25155.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37239.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25155.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25016.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":25155.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25155.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":27932.59,"maximum":50556.73,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50556.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40662.99},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":34696.08},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28508.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29222.01},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34520.06},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28087.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39321.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38821.87},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28087.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29491.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47748.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40694.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28564.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28087.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28087.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40666.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28087.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27932.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":28087.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28087.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":21827.81,"maximum":39507.35,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39507.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30569.72},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":26083.9},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22277.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21968.6},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25951.58},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21948.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30727.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29185.6},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21948.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37312.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30593.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22321.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21948.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21948.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30572.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21948.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21827.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":21948.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21948.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16281.58,"maximum":30085.07,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30085.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22656.13},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19331.56},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16964.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16281.58},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19233.49},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16713.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23399.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21630.32},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16713.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17549.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28413.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22673.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16998.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16713.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16713.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22658.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16713.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16713.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16713.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":23761.87,"10th_percentile":23761.87,"90th_percentile":23761.87,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14244.9,"10th_percentile":14244.9,"90th_percentile":14244.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16042.69,"maximum":29036.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29036.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22775.11},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19433.08},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16373.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16367.08},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19334.49},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16131.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22583.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21743.91},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16131.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16937.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27423.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22792.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16405.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16131.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16131.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22777.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16131.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16042.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16131.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16131.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":4979.5,"10th_percentile":4979.5,"90th_percentile":4979.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":23932.56,"10th_percentile":23104.31,"90th_percentile":24044.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15055.94,"10th_percentile":15055.94,"90th_percentile":15055.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7627.79,"maximum":15189.73,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15189.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10614.21},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9056.68},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8565.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7627.79},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9010.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8438.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11814.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10133.63},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8438.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8860.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14345.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10622.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8582.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8438.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8438.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10615.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8438.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8392.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8438.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8438.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7536.41,"10th_percentile":7536.41,"90th_percentile":7536.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":19564.67,"maximum":35411.17,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35411.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29185.91},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":24903.16},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19967.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20974.14},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24776.82},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19672.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27542.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27864.45},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19672.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20656.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33443.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29208.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20007.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19672.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19672.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29188.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19672.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19564.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19672.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19672.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":26979.1,"10th_percentile":26979.1,"90th_percentile":26979.1,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6025.58,"10th_percentile":6025.58,"90th_percentile":6025.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":119.0,"10th_percentile":119.0,"90th_percentile":119.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14603.17,"maximum":26431.07,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26431.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21104.83},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18007.9},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14904.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15166.76},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17916.54},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14683.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20557.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20149.26},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14683.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15418.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24962.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21121.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14933.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14683.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14683.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21106.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14683.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14603.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14683.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14683.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14329.6,"maximum":25935.93,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25935.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20187.68},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17225.33},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14624.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14507.66},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17137.95},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14408.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20172.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19273.64},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14408.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15129.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24495.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20203.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14653.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14408.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14408.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20189.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14408.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14329.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14408.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14408.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":19274.74,"10th_percentile":19274.74,"90th_percentile":19274.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":20400.83,"10th_percentile":20400.83,"90th_percentile":20400.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13505.48,"10th_percentile":13505.48,"90th_percentile":13505.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6093.76,"maximum":12050.75,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12050.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8479.59},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7235.29},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6795.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6093.76},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7198.58},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6694.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9372.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8095.65},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6694.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11381.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8486.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6808.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6694.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6694.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8480.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6694.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6658.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6694.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6694.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15216.14,"maximum":27540.52,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27540.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21764.39},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18570.68},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15529.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15640.74},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18476.47},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15300.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21420.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20778.96},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15300.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16065.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26010.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21781.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15560.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15300.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15300.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21766.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15300.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15216.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15300.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15300.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":21799.05,"10th_percentile":21799.05,"90th_percentile":21799.05,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13932.8,"10th_percentile":13932.8,"90th_percentile":13932.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6731.28,"maximum":13244.9,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13244.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9366.71},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7992.23},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7468.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6731.28},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7951.69},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7358.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10301.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8942.61},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7358.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7726.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12509.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9374.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7358.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7358.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9367.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7358.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7317.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7358.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7358.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":15690.54,"10th_percentile":15690.54,"90th_percentile":15690.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6825.46,"10th_percentile":6825.46,"90th_percentile":6825.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":49507.78,"maximum":89606.84,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89606.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":74589.43},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":63644.13},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50528.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":53602.88},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63321.26},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69694.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71212.21},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52270.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84628.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74647.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50627.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74595.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49507.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49781.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":45757.58,"maximum":82819.15,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82819.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":70556.97},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":60203.4},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46700.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":50705.0},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59897.99},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46010.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64414.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67362.33},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46010.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48311.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78218.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70611.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46792.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46010.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46010.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70563.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":46010.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45757.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":46010.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46010.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":24766.09,"maximum":44825.51,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44825.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39180.99},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":33431.55},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25276.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":28156.99},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33261.95},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24903.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34864.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37406.98},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24903.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26148.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42335.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39211.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25326.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24903.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24903.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39184.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24903.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24766.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":24903.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24903.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24896.6,"10th_percentile":24896.6,"90th_percentile":27037.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","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":24434.3,"10th_percentile":24434.3,"90th_percentile":24434.3,"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."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14444.45,"maximum":26143.79,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26143.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20206.16},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17241.1},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14742.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14520.94},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17153.64},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14524.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20334.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19291.28},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14524.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24691.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20221.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14771.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14524.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14524.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20207.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14524.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14444.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14524.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14524.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":13184.7,"10th_percentile":13184.7,"90th_percentile":13184.7,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":17071.34,"10th_percentile":17071.34,"90th_percentile":17071.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12866.46,"10th_percentile":12866.46,"90th_percentile":12866.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12598.43,"maximum":24134.09,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24134.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17530.95},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14958.45},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13608.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12598.43},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14882.57},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18770.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16737.2},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13407.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14078.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22793.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17544.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17532.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13407.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13334.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13407.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":119.0,"10th_percentile":119.0,"90th_percentile":119.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":40006.1,"maximum":72409.23,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72409.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":59288.97},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":50588.88},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40830.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":42607.37},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50332.24},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40227.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56318.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56604.52},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40227.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42238.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68386.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59335.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40911.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40227.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40227.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59294.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":40227.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40006.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":40227.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40227.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":50284.12,"10th_percentile":50284.12,"90th_percentile":50284.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":35702.54,"10th_percentile":35702.54,"90th_percentile":35702.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":95098.71,"10th_percentile":95098.71,"90th_percentile":95098.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40031.1,"10th_percentile":40031.1,"90th_percentile":40031.1,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":41529.07,"maximum":76247.24,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76247.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":57788.5},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":49308.58},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42994.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":41529.07},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49058.44},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42359.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59303.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55171.98},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42359.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44477.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72011.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57833.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43079.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42359.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42359.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57793.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":42359.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42126.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":42359.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42359.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17597.78,"maximum":31851.18,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31851.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25565.83},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21814.28},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17960.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18372.6},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21703.62},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17695.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24773.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24408.27},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17695.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18579.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30081.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25585.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17995.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17695.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17695.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25568.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17695.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17597.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17695.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17695.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11097.39,"10th_percentile":11097.39,"90th_percentile":11097.39,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":22023.08,"10th_percentile":22023.08,"90th_percentile":22023.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":25341.76,"10th_percentile":25341.76,"90th_percentile":25341.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17516.01,"10th_percentile":17516.01,"90th_percentile":17516.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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","minimum":10192.8,"maximum":14194.52,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14183.47},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12102.18},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10192.8},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12040.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13541.28},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14194.52},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14184.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9655.72,"maximum":18397.58,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18397.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13436.12},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11464.5},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10374.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9655.72},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11406.34},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14309.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12827.77},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10220.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10731.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17375.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13446.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10394.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13437.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10220.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10164.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10220.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":4644.41,"maximum":10050.3,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10050.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":6462.78},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":5514.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5667.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4644.41},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5486.46},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5583.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7816.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6170.17},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5583.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5862.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9491.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6467.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5678.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5583.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5583.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6463.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5583.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5552.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":5583.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5583.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":6062.74,"10th_percentile":6062.74,"90th_percentile":6062.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":5514.43,"10th_percentile":5514.43,"90th_percentile":5514.43,"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":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4829.62,"10th_percentile":4829.62,"90th_percentile":5531.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":34056.39,"maximum":61640.53,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61640.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50737.77},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":43292.48},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34758.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":36462.14},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43072.86},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34244.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47942.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48440.49},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34244.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35956.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58216.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50777.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34826.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34244.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34244.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50742.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":34244.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34056.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":34244.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34244.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":19290.38,"maximum":34914.71,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34914.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28046.98},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":23931.35},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19688.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20155.66},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23809.95},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19397.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27155.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26777.09},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19397.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20366.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32975.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28068.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19726.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19397.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19397.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28049.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19397.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19290.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19397.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19397.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":27531.76,"maximum":49831.24,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49831.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41859.67},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":35717.16},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28099.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":30081.99},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35535.96},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27684.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38757.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39964.37},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27684.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29068.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47062.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41892.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28154.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27684.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27684.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41863.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27684.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27531.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":27684.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27684.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26721.07,"10th_percentile":26721.07,"90th_percentile":26721.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7312.35,"maximum":14081.62,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14081.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10175.28},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8682.15},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7940.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7312.35},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8638.11},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7823.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10952.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9714.57},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7823.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8214.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13299.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10183.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7956.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7823.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7823.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10176.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7823.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7780.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7823.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7823.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18422.13,"maximum":33343.22,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33343.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26011.7},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22194.73},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18801.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18693.02},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22082.13},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18524.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25933.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24833.95},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18524.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19450.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31490.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26031.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18838.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18524.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18524.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26013.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18524.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18422.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18524.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18524.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17050.75,"10th_percentile":17050.75,"90th_percentile":17050.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33595.97,"10th_percentile":33595.97,"90th_percentile":33595.97,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17055.76,"maximum":30870.16,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30870.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24389.94},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":20810.94},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17407.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17527.56},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20705.37},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17150.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24010.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23285.62},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17150.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18007.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29155.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24408.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17441.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17150.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17150.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24392.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17150.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17055.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17150.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17150.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6219.94,"maximum":13154.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13154.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8655.16},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7385.1},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7417.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6219.94},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7347.64},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7308.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10231.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8263.28},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7308.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7673.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12424.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8661.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7432.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7308.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7308.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8655.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7308.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7268.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7308.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7308.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":4541.48,"maximum":9757.73,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9757.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":6319.55},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":5392.22},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5502.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4541.48},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5364.86},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5420.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7589.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6033.42},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5420.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5692.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9215.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6324.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5513.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5420.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5420.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6320.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5420.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5391.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":5420.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5420.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":6029.46,"10th_percentile":6029.46,"90th_percentile":6029.46,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":4412.52,"10th_percentile":4412.52,"90th_percentile":4412.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":4721.25,"10th_percentile":4721.25,"90th_percentile":4721.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4217.77,"10th_percentile":4217.77,"90th_percentile":4217.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4933.71,"10th_percentile":4933.71,"90th_percentile":4962.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9331.15,"maximum":17710.47,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17710.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12984.48},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11079.13},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9986.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9331.15},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11022.92},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9839.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13774.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12396.57},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9839.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16726.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12994.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10006.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9839.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9839.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12985.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9839.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9839.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9839.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10660.79,"10th_percentile":10660.79,"90th_percentile":10660.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":24475.91,"10th_percentile":24475.91,"90th_percentile":24475.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":12258.94,"10th_percentile":12258.94,"90th_percentile":12258.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":12092.2,"10th_percentile":12092.2,"90th_percentile":12092.2,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":11382.14,"10th_percentile":11382.14,"90th_percentile":11382.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8943.94,"10th_percentile":8943.94,"90th_percentile":8943.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":22714.86,"maximum":46288.44,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46288.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31608.16},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":26969.96},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26101.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22714.86},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26833.14},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25715.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36002.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30177.02},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25715.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27001.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43716.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31632.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26152.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25715.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25715.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31610.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25715.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25574.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":25715.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25715.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10937.4,"maximum":20637.63,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20637.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15219.6},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12986.27},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11637.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10937.4},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12920.39},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11465.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16051.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14530.49},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11465.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12038.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19491.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15231.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11660.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11465.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11465.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15220.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11465.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11402.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11465.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11465.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":13534.93,"10th_percentile":13534.93,"90th_percentile":13534.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":15542.78,"10th_percentile":15542.78,"90th_percentile":15542.78,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":2200.0,"10th_percentile":2200.0,"90th_percentile":2200.0},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11414.55,"10th_percentile":11414.55,"90th_percentile":11414.55,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":54213.28,"maximum":98123.58,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98123.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":81997.08},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":69964.79},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55330.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":58926.31},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69609.85},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54513.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76318.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78284.46},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54513.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57238.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92672.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82060.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55439.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54513.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54513.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82004.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":54513.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54213.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":54513.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54513.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":96347.97,"10th_percentile":92923.3,"90th_percentile":105031.76,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51034.49,"10th_percentile":49524.18,"90th_percentile":53089.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":85530.08,"10th_percentile":85530.08,"90th_percentile":85530.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":38078.83,"10th_percentile":38078.83,"90th_percentile":38078.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":51382.68,"10th_percentile":41713.13,"90th_percentile":57409.41,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":82789.36,"10th_percentile":82789.36,"90th_percentile":82789.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2398.98,"10th_percentile":2398.98,"90th_percentile":2398.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":51189.2,"10th_percentile":47324.46,"90th_percentile":53946.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51472.08,"10th_percentile":51472.08,"90th_percentile":51472.08,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9360.21,"maximum":17530.42,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17530.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13024.91},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11113.63},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9885.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9360.21},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11057.25},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9739.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13634.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12435.17},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9739.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10226.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16556.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13035.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9904.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9739.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9739.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13026.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9739.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9685.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9739.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9739.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":8338.16,"10th_percentile":8338.16,"90th_percentile":8338.16,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8305.71,"10th_percentile":8305.71,"90th_percentile":8305.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9080.97,"10th_percentile":9080.97,"90th_percentile":9080.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13633.98,"maximum":24676.88,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24676.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19457.66},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16602.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13915.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13983.03},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16518.21},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13709.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19193.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18576.67},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13709.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23305.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19472.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13942.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13709.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13709.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19459.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13709.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13633.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13709.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13709.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":19593.39,"10th_percentile":19593.39,"90th_percentile":19593.39,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11881.74,"10th_percentile":11881.74,"90th_percentile":11881.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":45029.78,"maximum":81501.86,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81501.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":66291.19},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":56563.58},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45957.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":47639.44},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56276.63},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45278.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63390.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63289.69},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45278.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47542.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76973.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66342.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46048.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45278.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45278.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66296.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":45278.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45029.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":45278.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45278.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":27207.72,"maximum":49244.74,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49244.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39561.02},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":33755.81},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27768.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":28430.09},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33584.57},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27358.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38301.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37769.8},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27358.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28726.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46508.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39591.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27823.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27358.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27358.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39564.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27358.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27207.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":27358.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27358.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19659.06,"10th_percentile":19659.06,"90th_percentile":19659.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17906.09,"maximum":32683.91,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32683.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24916.66},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21260.38},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18430.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17906.09},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21152.52},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18157.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25420.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23788.5},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18157.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19065.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30868.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24936.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18466.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18157.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18157.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24918.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18157.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18057.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18157.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18157.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":23585.32,"10th_percentile":23585.32,"90th_percentile":23585.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":21010.82,"10th_percentile":21010.82,"90th_percentile":21010.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14948.55,"10th_percentile":14948.55,"90th_percentile":14948.55,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":21151.78,"maximum":39253.18,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39253.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29433.1},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":25114.07},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22134.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21151.78},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24986.67},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21807.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30530.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28100.45},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21807.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22897.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37072.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29456.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22178.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21807.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21807.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29435.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21807.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21687.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":21807.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21807.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12990.74,"10th_percentile":12990.74,"90th_percentile":12990.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":21631.72,"10th_percentile":21631.72,"90th_percentile":21631.72,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":40225.8,"10th_percentile":40225.8,"90th_percentile":40225.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19064.76,"10th_percentile":17116.76,"90th_percentile":19121.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15651.54,"maximum":29119.95,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29119.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21779.41},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18583.49},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16420.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15651.54},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18489.21},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16177.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22648.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20793.29},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16177.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16986.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27502.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21796.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16452.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16177.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16177.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21781.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16177.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16088.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16177.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16177.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":23493.58,"10th_percentile":23493.58,"90th_percentile":25125.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11256.74,"maximum":20374.18,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20374.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16137.9},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13769.82},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11488.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11597.33},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13699.96},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15846.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15407.22},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11884.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19242.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16150.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16139.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11256.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":212.5,"10th_percentile":212.5,"90th_percentile":212.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":250.75,"10th_percentile":250.75,"90th_percentile":250.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10964.41,"10th_percentile":10944.41,"90th_percentile":10985.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":23505.79,"maximum":42544.42,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42544.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33012.76},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":28168.45},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23990.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":23724.26},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28025.55},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23635.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33090.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31518.02},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23635.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24817.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40180.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33038.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24037.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23635.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23635.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33015.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23635.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23505.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":23635.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23635.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19782.11,"10th_percentile":19782.11,"90th_percentile":19782.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":28748.91,"maximum":52034.22,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52034.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41396.47},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":35321.93},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29341.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29749.12},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35142.74},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28907.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40471.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39522.15},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28907.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30353.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49143.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41428.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29399.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28907.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28907.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41400.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28907.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28748.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":28907.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28907.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6731.28,"maximum":13247.55,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13247.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9366.71},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7992.23},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7470.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6731.28},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7951.69},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7359.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10303.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8942.61},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7359.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7727.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12511.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9374.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7359.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7359.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9367.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7359.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7359.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7359.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6694.49,"10th_percentile":6694.49,"90th_percentile":6694.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5540.65,"10th_percentile":5540.65,"90th_percentile":5540.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6786.9,"10th_percentile":5702.47,"90th_percentile":7289.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6273.07,"maximum":12545.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12545.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8729.09},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7448.18},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7074.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6273.07},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7410.39},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6969.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9757.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8333.86},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6969.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7318.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11848.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8735.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6969.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6969.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8729.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6969.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6931.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6969.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6969.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1539.17,"10th_percentile":1539.17,"90th_percentile":1539.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10843.6,"maximum":19717.52,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19717.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15089.07},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12874.89},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11118.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10843.6},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12809.58},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10954.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15335.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14405.88},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10954.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11501.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18622.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15100.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11140.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10954.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10954.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15090.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10954.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10893.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10954.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10954.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6786.9,"maximum":13198.57,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13198.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9444.1},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8058.27},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7442.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6786.9},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8017.39},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7332.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10265.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9016.49},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7332.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7699.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12465.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9451.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7457.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7332.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7332.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9444.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7332.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7292.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7332.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7332.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7200.51,"10th_percentile":7200.51,"90th_percentile":7200.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9483.06,"maximum":17731.66,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17731.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13195.86},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11259.49},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9998.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9483.06},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11202.37},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9850.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13791.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12598.39},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9850.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10343.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16746.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13206.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10018.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9850.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9850.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13197.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9850.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9796.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9850.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9850.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9130.28,"10th_percentile":9130.28,"90th_percentile":9130.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14051.65,"maximum":25432.85,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25432.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20478.77},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17473.7},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14341.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14716.84},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17385.06},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14129.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19781.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19551.54},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14129.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14835.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24019.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20494.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14369.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14129.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14129.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20480.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14129.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14051.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14129.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14129.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":19084.39,"10th_percentile":19084.39,"90th_percentile":19084.39,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13551.43,"10th_percentile":13551.43,"90th_percentile":13551.43,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12263.55,"10th_percentile":12263.55,"90th_percentile":12263.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7044.23,"maximum":14031.31,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14031.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9802.18},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8363.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7912.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7044.23},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8321.37},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7795.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10913.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9358.36},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7795.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8184.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13251.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9809.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7927.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7795.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7795.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9803.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7795.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7752.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7795.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7795.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11808.26,"maximum":21372.41,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21372.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16973.04},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14482.41},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12051.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12197.49},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14408.94},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16622.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16204.54},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11873.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12467.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20185.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16986.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12075.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16974.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11873.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11808.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11873.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":12345.21,"10th_percentile":12345.21,"90th_percentile":12345.21,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11758.04,"10th_percentile":11758.04,"90th_percentile":11758.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6179.89,"10th_percentile":6179.89,"90th_percentile":6179.89,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11322.16,"10th_percentile":10177.93,"90th_percentile":23989.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":26920.99,"maximum":48725.77,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48725.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44643.46},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":38092.45},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27475.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":32082.53},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37899.21},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27069.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37897.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42622.12},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27069.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28423.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46018.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44678.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27530.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27069.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27069.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44647.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27069.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26920.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":27069.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27069.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26797.36,"10th_percentile":26797.36,"90th_percentile":26797.36,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26417.4,"10th_percentile":26417.4,"90th_percentile":26417.4,"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":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":11288.28,"10th_percentile":11288.28,"90th_percentile":11288.28,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8326.73,"maximum":19129.7,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19129.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11586.81},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9886.55},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - 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Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10627.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10569.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10627.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10627.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7613.68,"maximum":14420.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14420.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10594.58},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9039.92},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8131.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7613.68},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8994.06},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8011.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11215.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10114.88},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8011.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8411.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13619.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10602.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8147.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8011.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8011.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10595.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8011.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8011.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8011.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10463.32,"10th_percentile":7010.09,"90th_percentile":11070.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":255.0,"10th_percentile":255.0,"90th_percentile":255.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7597.88,"10th_percentile":7525.27,"90th_percentile":7657.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7870.25,"10th_percentile":7870.25,"90th_percentile":7870.25,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10070.32,"10th_percentile":10070.32,"90th_percentile":13167.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":4950.47,"10th_percentile":4950.47,"90th_percentile":4950.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":6220.67,"10th_percentile":6220.67,"90th_percentile":6220.67,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":7204.57,"10th_percentile":7204.57,"90th_percentile":7204.57,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6672.8,"10th_percentile":6672.8,"90th_percentile":7531.76,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":9515.04,"10th_percentile":9515.04,"90th_percentile":9515.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":15537.73,"10th_percentile":13722.8,"90th_percentile":25332.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6240.7,"10th_percentile":5999.26,"90th_percentile":10904.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":35800.93,"maximum":64798.06,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64798.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53215.46},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":45406.59},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36538.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":38242.71},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45176.24},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35998.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50398.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50806.0},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35998.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37798.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61198.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53256.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36610.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35998.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35998.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53220.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":35998.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35800.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":35998.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35998.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12483.87,"maximum":23100.12,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23100.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17371.55},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14822.44},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13025.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12483.87},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14747.24},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12833.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17966.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16585.01},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12833.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13475.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21816.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17385.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13051.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12833.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12833.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17373.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12833.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12762.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12833.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12833.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":17592.09,"10th_percentile":17592.09,"90th_percentile":17592.09,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":17343.69,"10th_percentile":17343.69,"90th_percentile":17343.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11714.42,"10th_percentile":11714.42,"90th_percentile":11714.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13673.41,"maximum":25714.84,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25714.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19026.81},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16234.8},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14500.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13673.41},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16152.44},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14286.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20000.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18165.32},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14286.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15000.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24286.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19041.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14528.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14286.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14286.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19028.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14286.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14207.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14286.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14286.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12629.12,"10th_percentile":12629.12,"90th_percentile":12629.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18517.95,"maximum":33516.65,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33516.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26663.17},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":22750.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18899.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19161.2},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22635.19},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26068.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25455.93},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19551.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31654.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26683.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18936.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26665.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18517.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18620.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17487.59,"10th_percentile":17487.59,"90th_percentile":25576.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9715.49,"maximum":17917.0,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17917.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13519.29},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11535.46},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10103.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9715.49},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11476.94},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9953.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13935.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12907.17},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9953.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10451.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16921.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13529.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10123.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9953.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9953.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13520.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9953.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9899.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9953.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9953.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":13779.55,"10th_percentile":13779.55,"90th_percentile":13779.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9306.11,"10th_percentile":9306.11,"90th_percentile":9306.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":24784.87,"10th_percentile":24784.87,"90th_percentile":24784.87},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":8056.9,"10th_percentile":8056.9,"90th_percentile":9400.28,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":13403.79,"10th_percentile":13403.79,"90th_percentile":13403.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7422.06,"10th_percentile":247.33,"90th_percentile":9382.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8465.36,"maximum":15993.34,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15993.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11779.71},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10051.15},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9018.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8465.36},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10000.16},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8885.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12439.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11246.35},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8885.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9329.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15104.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11788.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9036.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8885.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8885.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11780.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8885.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8885.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8885.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7430.73,"10th_percentile":7430.73,"90th_percentile":7430.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8248.6,"10th_percentile":8248.6,"90th_percentile":8248.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":150.35,"10th_percentile":150.35,"90th_percentile":150.35,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6464.51,"10th_percentile":5908.46,"90th_percentile":8422.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12002.42,"maximum":22459.34,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22459.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16701.59},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14250.79},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12664.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12002.42},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14178.5},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12477.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17468.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15945.39},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12477.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21211.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16714.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12477.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12477.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16703.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12477.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12408.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12477.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12477.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6048.11,"maximum":11236.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11236.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8416.06},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7181.08},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6336.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6048.11},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7144.65},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6242.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8739.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8035.0},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6554.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10612.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8422.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6348.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6242.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6242.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8416.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6242.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6242.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6242.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10075.75,"maximum":20368.89,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20368.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14020.6},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11963.21},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11485.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10075.75},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11902.52},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11316.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15842.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13385.79},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11316.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11881.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19237.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14031.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11508.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11316.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11316.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14021.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11316.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11253.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11316.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11316.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9949.58,"maximum":18981.41,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18981.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13845.03},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11813.4},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10703.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9949.58},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11753.47},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14763.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13218.16},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10545.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17926.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13855.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10724.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13846.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10545.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10545.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":13958.2,"10th_percentile":13958.2,"90th_percentile":13958.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14883.32,"maximum":26938.13,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26938.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20898.07},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":17831.48},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15190.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15018.17},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17741.02},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14965.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20951.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19951.86},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14965.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15713.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25441.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20914.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15220.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14965.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14965.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20899.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14965.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14883.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14965.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14965.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9100.39,"maximum":16742.68,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16742.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12663.36},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10805.13},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9441.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9100.39},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10750.32},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9301.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13022.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12090.0},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9301.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9766.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15812.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12673.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9459.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9301.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9301.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12664.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9301.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9250.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9301.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9301.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"17","median_amount":6039.0,"10th_percentile":4268.48,"90th_percentile":6438.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":5470.05,"10th_percentile":5470.05,"90th_percentile":6438.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5779.82,"10th_percentile":5779.82,"90th_percentile":5779.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":7213.81,"10th_percentile":7213.81,"90th_percentile":7213.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":5703.3,"10th_percentile":5703.3,"90th_percentile":5703.3,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":6399.56,"10th_percentile":5240.8,"90th_percentile":6691.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6724.79,"10th_percentile":6724.79,"90th_percentile":6724.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13412.76,"maximum":24393.58,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24393.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18664.11},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15925.32},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13755.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13412.76},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15844.53},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13551.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18972.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.04},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13551.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14229.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23038.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18678.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13782.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13551.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13551.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18665.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13551.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13477.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13551.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13551.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":4748.0,"10th_percentile":4748.0,"90th_percentile":4748.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9073.82,"10th_percentile":9073.82,"90th_percentile":9208.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8094.0,"10th_percentile":8094.0,"90th_percentile":8094.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":12548.4,"10th_percentile":12548.4,"90th_percentile":12548.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":8983.14,"10th_percentile":8983.14,"90th_percentile":8983.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":12207.64,"maximum":22095.27,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22095.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17051.59},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14549.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12459.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12253.94},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14475.62},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12275.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17185.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16279.53},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12275.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12888.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20867.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17064.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12275.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12275.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17053.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12275.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12207.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12275.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12275.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":1306.8,"10th_percentile":1306.8,"90th_percentile":2115.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"75","median_amount":1881.6,"10th_percentile":920.69,"90th_percentile":2455.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":1023.0,"10th_percentile":660.8,"90th_percentile":2763.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":669.82,"10th_percentile":446.55,"90th_percentile":4361.78,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":6962.22,"10th_percentile":6962.22,"90th_percentile":6962.22},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"15","median_amount":4828.49,"10th_percentile":3759.11,"90th_percentile":7242.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"17","median_amount":5146.9,"10th_percentile":3239.6,"90th_percentile":8213.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":2385.0,"10th_percentile":2385.0,"90th_percentile":2385.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":1345.0,"10th_percentile":950.29,"90th_percentile":2690.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"37","median_amount":1961.0,"10th_percentile":1530.0,"90th_percentile":4706.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"39","median_amount":3931.95,"10th_percentile":2398.98,"90th_percentile":4797.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":29755.76,"maximum":55301.63,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55301.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41405.71},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":35329.82},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31183.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29755.76},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35150.59},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30723.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43012.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39530.97},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30723.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32259.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52229.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41437.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31245.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30723.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30723.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41409.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":30723.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30554.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":30723.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30723.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7900.06,"maximum":16411.72,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16411.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10993.09},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9379.96},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9254.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7900.06},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9332.37},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9117.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12764.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10495.35},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9117.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15499.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11001.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9272.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9117.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9117.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10994.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9117.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9067.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9117.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9117.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9891.1,"maximum":17902.44,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17902.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14877.69},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12694.53},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10094.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10691.69},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12630.13},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9945.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13924.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14204.06},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9945.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10443.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16907.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14889.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9945.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9945.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14878.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9945.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9891.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9945.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9945.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":35628.3,"maximum":64485.61,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64485.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55158.34},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":47064.37},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36362.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":39638.94},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46825.61},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50155.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52660.91},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35825.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37616.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60903.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55201.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36434.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55163.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":35825.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35628.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":35825.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35825.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":41568.5,"maximum":75237.1,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75237.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":63841.22},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":54473.13},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42425.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":45878.8},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54196.78},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41798.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58517.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60950.65},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41798.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43888.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71057.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63890.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42508.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41798.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41798.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63846.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":41798.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41568.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":41798.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41798.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":31659.92,"10th_percentile":31659.92,"90th_percentile":31659.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8730.99,"maximum":15932.45,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15932.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12149.34},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10366.54},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8984.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8730.99},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10313.95},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8851.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12391.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11599.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8851.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9293.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15047.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12158.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9001.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8851.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8851.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12150.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8851.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8802.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8851.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8851.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8630.2,"10th_percentile":8630.2,"90th_percentile":8630.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":64752.91,"maximum":117199.84,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117199.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":106399.73},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":90786.57},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66087.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":76463.0},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":90326.01},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65111.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91155.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101582.22},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65111.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68366.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110688.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106482.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66217.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65111.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65111.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106408.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":65111.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64752.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":65111.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65111.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8300.17,"maximum":15766.96,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15766.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11549.84},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9855.01},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8890.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8300.17},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9805.02},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8759.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12263.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11026.9},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8759.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9197.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14891.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11558.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8908.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8759.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8759.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11550.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8759.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8711.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8759.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8759.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10823.81,"10th_percentile":10823.81,"90th_percentile":10823.81,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":7342.16,"10th_percentile":7342.16,"90th_percentile":7342.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":8169.18,"10th_percentile":8169.18,"90th_percentile":8169.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15620.63,"maximum":28272.64,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28272.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22666.53},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":19340.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15942.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16289.05},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19242.31},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15707.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21989.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21640.24},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15707.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16492.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26701.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22684.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15974.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15707.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15707.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22668.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15707.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15620.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15707.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15707.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"23","median_amount":21431.32,"10th_percentile":19170.8,"90th_percentile":22664.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"26","median_amount":14522.41,"10th_percentile":11861.18,"90th_percentile":15435.97,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":16124.69,"10th_percentile":16124.69,"90th_percentile":16124.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"11","median_amount":14180.9,"10th_percentile":7412.0,"90th_percentile":39534.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":28669.26,"10th_percentile":28669.26,"90th_percentile":28669.26,"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":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":18951.07,"10th_percentile":18951.07,"90th_percentile":18951.07,"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":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14795.21,"10th_percentile":14795.21,"90th_percentile":14795.21,"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":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":23755.48,"10th_percentile":23755.48,"90th_percentile":23755.48,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"11","median_amount":11045.7,"10th_percentile":6014.72,"90th_percentile":13973.73,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13083.9,"10th_percentile":13083.9,"90th_percentile":16129.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"11","median_amount":21760.51,"10th_percentile":9472.64,"90th_percentile":24945.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":10061.3,"10th_percentile":3348.29,"90th_percentile":12978.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"83","median_amount":13366.53,"10th_percentile":7020.82,"90th_percentile":15401.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15061.44,"10th_percentile":14912.36,"90th_percentile":15634.77,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11629.05,"maximum":21048.05,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21048.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16281.13},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":13892.03},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11868.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11700.26},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13821.56},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16370.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15543.97},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11693.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12278.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19878.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16293.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11892.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16282.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11693.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11629.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11693.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":5889.93,"10th_percentile":5889.93,"90th_percentile":5889.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"44","median_amount":6212.0,"10th_percentile":1800.0,"90th_percentile":12996.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"12","median_amount":4361.78,"10th_percentile":1703.0,"90th_percentile":22414.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":9894.6,"10th_percentile":9605.5,"90th_percentile":11579.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":4628.0,"10th_percentile":2352.0,"90th_percentile":10293.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"86","median_amount":15167.3,"10th_percentile":5992.88,"90th_percentile":27363.21,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"53","median_amount":13682.83,"10th_percentile":5661.48,"90th_percentile":19742.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"19","median_amount":9177.36,"10th_percentile":2680.0,"90th_percentile":15362.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7835.8,"10th_percentile":7835.8,"90th_percentile":7835.8,"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":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":14003.35,"10th_percentile":14003.35,"90th_percentile":14003.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"1 through 10","median_amount":12867.25,"10th_percentile":12867.25,"90th_percentile":33198.96,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"14","median_amount":6150.0,"10th_percentile":2920.0,"90th_percentile":11116.47,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"21","median_amount":3680.97,"10th_percentile":2269.95,"90th_percentile":6625.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"1 through 10","median_amount":13801.18,"10th_percentile":13801.18,"90th_percentile":16013.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"57","median_amount":13065.25,"10th_percentile":5652.07,"90th_percentile":20165.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10756.41,"10th_percentile":9499.88,"90th_percentile":11641.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"50","median_amount":9751.41,"10th_percentile":9134.68,"90th_percentile":11109.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11027.58,"10th_percentile":11027.58,"90th_percentile":11027.58,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":15415.82,"maximum":27901.94,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27901.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21916.87},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18700.77},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15733.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15750.32},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18605.9},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15501.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21701.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20924.53},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15501.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16276.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26351.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21933.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15764.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15501.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15501.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21918.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15501.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15415.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15501.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15501.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":18989.5,"10th_percentile":18989.5,"90th_percentile":18989.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15328.07,"10th_percentile":15328.07,"90th_percentile":15328.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13368.47,"maximum":24196.32,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24196.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18691.83},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15948.98},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13644.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13432.68},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15868.07},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13442.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18819.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17845.51},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13442.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14114.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22852.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18706.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13670.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13442.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13442.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18693.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13442.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13368.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13442.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13442.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5707.77,"maximum":11669.45,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11669.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7942.47},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6776.99},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6580.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5707.77},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6742.61},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6483.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9076.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7582.85},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6483.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11021.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7948.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6593.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6483.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6483.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7943.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6483.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6447.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":6483.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6483.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2391.49,"10th_percentile":2391.49,"90th_percentile":2391.49},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8000.5,"maximum":15282.41,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15282.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11132.85},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9499.21},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8617.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8000.5},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9451.02},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8490.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11886.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10628.79},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8490.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8914.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14433.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11141.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8634.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8490.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8490.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11133.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8490.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8443.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8490.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8490.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10297.37,"10th_percentile":10233.29,"90th_percentile":11345.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7319.34,"10th_percentile":7319.34,"90th_percentile":7319.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":21952.27,"10th_percentile":21952.27,"90th_percentile":21952.27,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":9977.72,"10th_percentile":9977.72,"90th_percentile":9977.72,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":7866.68,"10th_percentile":7866.68,"90th_percentile":8363.14,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9008.36,"10th_percentile":9008.36,"90th_percentile":9008.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":7055.18,"10th_percentile":1125.07,"90th_percentile":8010.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7949.31,"10th_percentile":7949.31,"90th_percentile":7949.31,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9453.18,"maximum":17464.21,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17464.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13154.28},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11224.01},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9847.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9453.18},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11167.07},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13583.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12558.69},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9702.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10187.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16493.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13164.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9867.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13155.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9702.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9648.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9702.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6849.43,"10th_percentile":6849.43,"90th_percentile":6849.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13770.04,"maximum":24923.14,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24923.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19345.61},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16506.83},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14053.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13902.51},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16423.09},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13846.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19384.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18469.69},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13846.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14538.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23538.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19360.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14081.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13846.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13846.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19347.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13846.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13770.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13846.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13846.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":15940.19,"10th_percentile":15940.19,"90th_percentile":15940.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":16659.12,"10th_percentile":16659.12,"90th_percentile":16659.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":25100.37,"maximum":45430.54,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45430.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37645.86},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":32121.69},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25617.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":27053.79},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31958.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25239.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35334.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35941.35},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25239.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26501.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42906.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37675.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25668.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25239.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25239.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37649.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25239.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25100.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":25239.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25239.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2353.04,"10th_percentile":2353.04,"90th_percentile":2353.04,"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":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15916.67,"10th_percentile":15916.67,"90th_percentile":15916.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10089.32,"maximum":18261.22,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18261.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14122.25},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12049.95},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10297.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10148.8},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11988.82},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10145.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14203.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13482.83},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10145.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10652.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17246.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14133.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10317.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10145.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10145.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14123.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10145.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10089.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10145.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10145.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":4976.45,"maximum":10565.32,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10565.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":6924.82},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":5908.67},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5957.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4976.45},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5878.7},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5869.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8217.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6611.29},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5869.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6163.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9978.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6930.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5969.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5869.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5869.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6925.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5869.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5837.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":5869.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5869.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11647.34,"maximum":21081.15,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21081.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16551.43},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14122.66},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11887.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11894.5},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14051.02},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11711.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16396.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15802.02},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11711.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19909.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16564.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11910.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11711.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11711.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16552.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11711.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11647.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11711.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11711.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14533.68,"maximum":26305.31,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26305.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22108.61},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18864.38},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14833.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15888.11},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18768.68},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14614.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20459.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21107.59},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14614.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15344.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24843.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22125.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14862.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14614.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14614.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22110.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14614.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14533.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14614.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14614.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":11986.37,"10th_percentile":11986.37,"90th_percentile":19408.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":22287.88,"10th_percentile":22287.88,"90th_percentile":22287.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":20465.6,"10th_percentile":20465.6,"90th_percentile":20465.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":20526.9,"10th_percentile":20526.9,"90th_percentile":20526.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13018.94,"10th_percentile":13018.94,"90th_percentile":13018.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":11920.9,"maximum":21576.29,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21576.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16821.72},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14353.29},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12166.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12088.75},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14280.48},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11986.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16781.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16060.08},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11986.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12586.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20377.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16834.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12190.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11986.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11986.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16823.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11986.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11920.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11986.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11986.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":15328.47,"10th_percentile":15328.47,"90th_percentile":15328.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11439.34,"10th_percentile":11439.34,"90th_percentile":11439.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":15744.6,"10th_percentile":15744.6,"90th_percentile":15744.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3304.15,"10th_percentile":3304.15,"90th_percentile":3304.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":15992.84,"10th_percentile":15992.84,"90th_percentile":15992.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5996.85,"10th_percentile":5996.85,"90th_percentile":5996.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":9418.09,"10th_percentile":587.9,"90th_percentile":11410.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6466.48,"maximum":12727.26,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12727.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8998.23},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7677.82},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7176.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6466.48},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7638.87},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7070.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9898.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8590.81},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7070.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7424.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12020.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9005.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7190.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7070.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7070.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8999.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7070.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7031.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7070.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7070.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14797.74,"maximum":26783.24,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26783.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21115.23},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18016.77},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15102.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15174.23},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17925.37},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14879.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20831.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20159.18},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14879.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15623.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25295.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21131.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15132.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14879.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14879.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21117.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14879.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14797.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14879.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14879.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12253.66,"10th_percentile":12253.66,"90th_percentile":12253.66,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19707.69,"10th_percentile":19707.69,"90th_percentile":19707.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":21118.21,"10th_percentile":21118.21,"90th_percentile":21118.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13931.49,"10th_percentile":13366.01,"90th_percentile":14721.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":24242.37,"maximum":43877.59,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43877.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39659.2},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":33839.59},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24742.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":28500.65},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33667.92},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34127.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37863.54},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24376.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25595.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41439.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39690.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24790.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39662.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24376.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24242.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":24376.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":32145.08,"maximum":58181.15,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58181.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48398.69},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":41296.64},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32807.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":34781.19},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41087.14},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32322.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45252.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46207.32},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32322.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33939.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54948.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48436.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32872.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32322.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32322.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48402.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32322.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32145.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":32322.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32322.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6011.58,"maximum":13018.52,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13018.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8365.23},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7137.72},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7341.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6011.58},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7101.51},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7232.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10125.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7986.48},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7232.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7594.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12295.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8371.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7355.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7232.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7232.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8365.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7232.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7192.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7232.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7232.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13513.3,"maximum":24458.45,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24458.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19416.08},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16566.95},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13791.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13953.15},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16482.91},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19023.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18536.97},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13588.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14267.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23099.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19431.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19417.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13588.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13513.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13588.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":19416.08,"10th_percentile":19416.08,"90th_percentile":19416.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12993.65,"10th_percentile":12993.65,"90th_percentile":12993.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":13410.37,"10th_percentile":13410.37,"90th_percentile":13410.37,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12944.69,"10th_percentile":12944.69,"90th_percentile":12944.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8878.75,"maximum":17114.71,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17114.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12354.95},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10541.98},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9650.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8878.75},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10488.5},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13311.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11795.55},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9508.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16163.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12364.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12356.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9508.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9508.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":9321.19,"maximum":17683.99,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17683.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12970.62},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":11067.3},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9971.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9321.19},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11011.16},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9824.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13754.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12383.34},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9824.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10315.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16701.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12980.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9991.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9824.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9824.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12971.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9824.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9770.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":9824.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9824.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16992.13,"maximum":30754.98,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30754.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24288.29},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":20724.21},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17342.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17454.51},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20619.08},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17086.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23920.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23188.58},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17086.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17940.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29046.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24307.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17376.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17086.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17086.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24290.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17086.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16992.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17086.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17086.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14832.85,"maximum":26846.78,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26846.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21099.06},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18002.97},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15138.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15162.61},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17911.64},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14914.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20880.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20143.74},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14914.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15660.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25355.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21115.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15168.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14914.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14914.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21100.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14914.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14914.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14914.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":10997.55,"10th_percentile":10997.55,"90th_percentile":10997.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10704.14,"maximum":22093.94,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22093.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14895.01},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12709.31},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12458.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10704.14},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12644.84},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17184.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14220.61},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12274.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12888.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20866.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14906.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14896.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12274.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12206.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":12274.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":5262.0,"maximum":10108.57,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10108.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7322.18},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":6247.72},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5700.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5262.0},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6216.02},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5615.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7862.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6990.65},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5615.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9546.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7327.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5711.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5615.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5615.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7322.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5615.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5584.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":5615.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5615.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":7262.54,"maximum":15236.08,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15236.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10105.97},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":8623.01},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8591.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7262.54},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8579.27},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8464.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11850.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9648.4},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8464.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8887.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14389.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10113.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8608.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8464.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8464.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10106.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8464.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8464.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8464.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":31911.02,"maximum":57757.5,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57757.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48174.6},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":41105.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32568.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":34620.15},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40896.9},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32087.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44922.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45993.38},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32087.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33691.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54548.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48212.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32632.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32087.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32087.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48178.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32087.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31911.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":32087.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32087.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":1636.8,"10th_percentile":826.0,"90th_percentile":2572.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":2439.55,"10th_percentile":2439.55,"90th_percentile":2439.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":16741.98,"10th_percentile":16741.98,"90th_percentile":16741.98},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":18913.08,"10th_percentile":18913.08,"90th_percentile":18913.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5146.9,"10th_percentile":5146.9,"90th_percentile":7176.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":2178.72,"10th_percentile":2178.72,"90th_percentile":2178.72,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":5414.0,"10th_percentile":5414.0,"90th_percentile":7874.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13627.75,"maximum":27827.8,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27827.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18963.28},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16180.6},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15691.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13627.75},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16098.51},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15459.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21643.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18104.67},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15459.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16232.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26281.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18978.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15459.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15459.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18964.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15459.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15374.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":15459.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15459.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10280.79,"maximum":19315.04,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19315.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14305.91},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12206.66},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10891.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10280.79},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12144.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15022.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13658.18},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10730.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11267.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18241.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14317.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10913.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14307.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10730.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10671.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10730.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":14305.91,"10th_percentile":14305.91,"90th_percentile":14610.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"1 through 10","median_amount":14307.15,"10th_percentile":14307.15,"90th_percentile":14307.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9801.13,"10th_percentile":9792.62,"90th_percentile":9947.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":18101.02,"maximum":32762.03,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32762.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29282.94},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":24985.95},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18474.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21043.87},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24859.19},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18201.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25481.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27957.08},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18201.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19111.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30941.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29305.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18510.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18201.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18201.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29285.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18201.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18101.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":18201.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18201.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":34527.09,"10th_percentile":34527.09,"90th_percentile":34527.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":7211.27,"10th_percentile":7211.27,"90th_percentile":7211.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10216.04,"maximum":20420.51,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20420.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14215.82},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12129.78},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11514.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10216.04},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12068.24},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11344.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15882.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13572.16},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11344.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11911.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19286.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14226.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11537.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11344.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11344.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14217.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11344.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11282.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11344.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11344.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":4314.86,"maximum":9478.39,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9478.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":6004.21},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":5123.15},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5344.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4314.86},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5097.16},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5265.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7372.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5732.35},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5265.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5529.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8951.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6008.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5355.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5265.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5265.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6004.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5265.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5236.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":5265.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5265.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":1292.24,"10th_percentile":1292.24,"90th_percentile":1292.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":3209.01,"10th_percentile":3209.01,"90th_percentile":3209.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":7018.63,"10th_percentile":7018.63,"90th_percentile":7018.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13015.14,"maximum":24153.95,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24153.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18110.81},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":15453.22},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13620.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13015.14},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15374.83},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13418.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18786.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17290.8},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13418.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14089.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22812.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18124.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13646.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13418.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13418.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18112.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13418.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13345.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13418.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13418.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":21230.94,"maximum":38427.05,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38427.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30851.57},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":26324.39},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21668.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22171.14},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26190.85},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21348.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29887.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29454.69},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21348.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22415.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36292.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30875.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21711.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21348.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21348.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30854.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21348.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21230.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":21348.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21348.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":14751.66,"maximum":26699.83,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26699.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21237.67},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":18121.24},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15055.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15262.22},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18029.31},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20766.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20276.08},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14833.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15574.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25216.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21254.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15085.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21239.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14833.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14751.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":14833.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":51969.16,"maximum":94061.83,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94061.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":80354.53},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":68563.26},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53040.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":57745.91},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68215.44},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52256.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73159.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76716.28},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52256.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54869.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88836.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80417.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53144.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52256.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52256.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80361.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":52256.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51969.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":52256.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52256.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":115866.0,"10th_percentile":115866.0,"90th_percentile":115866.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50168.27,"10th_percentile":50168.27,"90th_percentile":50168.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":35288.74,"10th_percentile":35288.74,"90th_percentile":35288.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50158.39,"10th_percentile":50107.5,"90th_percentile":50158.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":13180.48,"maximum":23856.07,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23856.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19291.33},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":16460.51},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13452.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13863.5},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16377.0},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13253.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18554.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18417.86},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13253.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13916.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22530.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19306.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13478.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13253.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13253.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19293.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13253.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13180.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":13253.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13253.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12776.42,"10th_percentile":12776.42,"90th_percentile":13151.81,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9368.74,"10th_percentile":9368.74,"90th_percentile":9368.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"1 through 10","median_amount":4435.21,"10th_percentile":4435.21,"90th_percentile":4435.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":11385.45,"10th_percentile":11385.45,"90th_percentile":12022.46,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":17946.22,"10th_percentile":17946.22,"90th_percentile":17946.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12386.76,"10th_percentile":251.99,"90th_percentile":13147.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":32108.51,"maximum":58114.94,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58114.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51173.24},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":43664.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32770.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":36775.09},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43442.54},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32286.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45200.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48856.25},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32286.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33900.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54886.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51213.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32834.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32286.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32286.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51177.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32286.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32108.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":32286.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32286.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10527.33,"maximum":19934.64,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19934.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14648.98},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":12499.38},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11240.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10527.33},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12435.97},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11074.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15504.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13985.71},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11074.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11628.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18827.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14660.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11263.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11074.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11074.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14650.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11074.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11013.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":11074.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11074.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"1 through 10","median_amount":2136.14,"10th_percentile":2136.14,"90th_percentile":2136.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10361.19,"10th_percentile":10361.19,"90th_percentile":10361.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9596.29,"10th_percentile":9596.29,"90th_percentile":9596.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8432.16,"maximum":15825.22,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15825.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11733.51},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10011.72},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8923.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8432.16},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9960.93},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8791.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12308.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11202.24},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8791.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9231.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14946.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11742.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8941.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8791.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8791.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11734.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8791.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8743.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8791.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8791.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":10431.51,"10th_percentile":9925.17,"90th_percentile":11734.66,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11671.18,"10th_percentile":11671.18,"90th_percentile":11671.18,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":16480.1,"maximum":29828.23,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29828.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25369.46},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21646.73},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16819.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18231.49},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21536.92},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16571.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23199.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24220.8},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16571.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17399.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28171.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25389.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16852.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16571.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16571.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25371.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16571.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16480.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":16571.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16571.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":265.52,"10th_percentile":265.52,"90th_percentile":265.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8955.95,"maximum":18306.23,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18306.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12462.37},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":10633.64},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10322.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8955.95},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10579.69},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10170.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14238.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11898.11},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10170.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10678.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17289.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12472.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10343.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10170.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10170.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12463.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10170.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10170.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10170.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":21408.69,"maximum":38748.76,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38748.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31379.45},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":26774.81},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21850.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22550.5},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26638.98},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30137.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29958.66},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21527.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22603.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36596.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31403.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21893.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31382.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21527.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21408.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":21527.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":10904.17,"maximum":19736.05,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19736.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16654.23},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":14210.38},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11128.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11968.38},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14138.29},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10964.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15350.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15900.17},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10964.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11512.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18639.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16667.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11150.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10964.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10964.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16655.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10964.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10904.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":10964.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10964.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"1 through 10","median_amount":19305.96,"10th_percentile":19305.96,"90th_percentile":19305.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":17581.69,"maximum":31822.06,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31822.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24784.98},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":21148.02},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17944.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17811.46},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21040.73},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17678.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24750.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23662.78},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17678.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18562.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30054.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24804.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17979.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17678.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17678.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24787.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17678.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17581.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":17678.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17678.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16148.35,"10th_percentile":16148.35,"90th_percentile":16148.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":6595.14,"maximum":13153.55,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13153.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9177.27},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":7830.59},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7417.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6595.14},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7790.87},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7307.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10230.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8761.75},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7307.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7672.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12422.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9184.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7431.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7307.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7307.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9178.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7307.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7267.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":7307.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7307.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"1 through 10","median_amount":9162.43,"10th_percentile":9162.43,"90th_percentile":9162.43,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5097.66,"10th_percentile":5097.66,"90th_percentile":5097.66,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8341.38,"10th_percentile":8341.38,"90th_percentile":8341.38,"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 Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"1 through 10","median_amount":6642.38,"10th_percentile":6642.38,"90th_percentile":6642.38,"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":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":13412.89,"10th_percentile":13412.89,"90th_percentile":13412.89},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":5569.44,"10th_percentile":486.4,"90th_percentile":6725.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":21945.35,"maximum":41532.95,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41532.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30537.38},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":26056.31},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23419.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21945.35},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25924.12},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23073.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32303.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29154.72},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23073.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24227.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39225.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30561.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23073.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23073.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30540.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23073.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22946.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":23073.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23073.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":8014.89,"maximum":14506.6,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14506.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11584.5},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"fee schedule","standard_charge_dollar":9884.58},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8180.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8325.07},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9834.44},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8059.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11282.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11059.98},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8059.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8462.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13700.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11593.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8196.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8059.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8059.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11585.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8059.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8014.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":8059.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8059.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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","minimum":102366.89,"maximum":102366.89,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102366.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70649.38,"maximum":70649.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":70649.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine liposome","code_information":[{"code":"0763","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":10943.19,"10th_percentile":10943.19,"90th_percentile":10943.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4557.13,"10th_percentile":4557.13,"90th_percentile":4557.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":8359.43,"10th_percentile":8359.43,"90th_percentile":8359.43,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":7679.51,"10th_percentile":7679.51,"90th_percentile":7679.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":19971.21,"10th_percentile":19971.21,"90th_percentile":19971.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3767.75,"10th_percentile":3767.75,"90th_percentile":3767.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"24","median_amount":4367.78,"10th_percentile":3548.27,"90th_percentile":10632.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4241.86,"10th_percentile":3344.0,"90th_percentile":10732.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2540.1,"10th_percentile":2540.1,"90th_percentile":2540.1,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":7169.57,"10th_percentile":7169.57,"90th_percentile":7169.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":224.73,"10th_percentile":224.73,"90th_percentile":224.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4535.35,"10th_percentile":4535.35,"90th_percentile":4535.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":6957.07,"10th_percentile":3623.38,"90th_percentile":12693.3,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":7652.49,"10th_percentile":7652.49,"90th_percentile":7652.49,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2434.03,"10th_percentile":2434.03,"90th_percentile":2434.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":50.0,"10th_percentile":50.0,"90th_percentile":50.0},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":7138.74,"10th_percentile":3278.11,"90th_percentile":11355.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9590.78,"10th_percentile":9590.78,"90th_percentile":9590.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3340.03,"10th_percentile":142.78,"90th_percentile":5674.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3403.86,"10th_percentile":3403.86,"90th_percentile":3403.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred acetate 1 mg","code_information":[{"code":"0790","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":49.19,"10th_percentile":49.19,"90th_percentile":49.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":220.46,"10th_percentile":220.46,"90th_percentile":220.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":102.87,"10th_percentile":102.87,"90th_percentile":102.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":241.9,"10th_percentile":241.9,"90th_percentile":241.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Injection,onabotulinumtoxinA","code_information":[{"code":"0902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":3316.32,"10th_percentile":3316.32,"90th_percentile":3316.32,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endo, single, urinary tract","code_information":[{"code":"2040","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":10236.0,"10th_percentile":10236.0,"90th_percentile":10236.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6483.57,"10th_percentile":6483.57,"90th_percentile":6483.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":7230.77,"10th_percentile":7230.77,"90th_percentile":7230.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9296.5,"10th_percentile":9296.5,"90th_percentile":9296.5,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":15546.0,"10th_percentile":13161.44,"90th_percentile":17691.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":13247.9,"10th_percentile":13247.9,"90th_percentile":13247.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6559.03,"10th_percentile":6014.92,"90th_percentile":6762.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cath coronary drug-delivery","code_information":[{"code":"2050","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":6752.0,"10th_percentile":6752.0,"90th_percentile":6752.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":107.6,"10th_percentile":93.0,"90th_percentile":169.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":133.74,"10th_percentile":60.24,"90th_percentile":258.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":113.08,"10th_percentile":49.45,"90th_percentile":115.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":276.8,"10th_percentile":276.8,"90th_percentile":276.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":123.6,"10th_percentile":123.6,"90th_percentile":123.6},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1122","median_amount":118.0,"10th_percentile":118.0,"90th_percentile":264.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"524","median_amount":118.0,"10th_percentile":115.69,"90th_percentile":250.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":175.69,"10th_percentile":75.0,"90th_percentile":489.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":112.13,"10th_percentile":89.47,"90th_percentile":123.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"21","median_amount":62.42,"10th_percentile":41.34,"90th_percentile":179.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"1 through 10","median_amount":118.0,"10th_percentile":118.0,"90th_percentile":118.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"957","median_amount":118.0,"10th_percentile":118.0,"90th_percentile":242.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":110.04,"10th_percentile":110.04,"90th_percentile":110.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":117.77,"10th_percentile":94.57,"90th_percentile":123.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":124.26,"10th_percentile":124.26,"90th_percentile":221.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":239.11,"10th_percentile":239.11,"90th_percentile":239.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"22","median_amount":262.4,"10th_percentile":203.36,"90th_percentile":552.4,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":147.42,"10th_percentile":147.42,"90th_percentile":147.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":328.0,"10th_percentile":328.0,"90th_percentile":328.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":102.4,"10th_percentile":102.4,"90th_percentile":102.4},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":130.07,"10th_percentile":130.07,"90th_percentile":135.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":135.11,"10th_percentile":130.07,"90th_percentile":312.07,"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":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":627.75,"10th_percentile":627.75,"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 Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":328.0,"10th_percentile":328.0,"90th_percentile":328.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":79.61,"10th_percentile":79.61,"90th_percentile":79.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":328.0,"10th_percentile":71.17,"90th_percentile":1107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"14","median_amount":101.16,"10th_percentile":101.16,"90th_percentile":105.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":84.44,"10th_percentile":75.94,"90th_percentile":114.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":84.9,"10th_percentile":84.9,"90th_percentile":84.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"42","median_amount":561.23,"10th_percentile":405.68,"90th_percentile":1145.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"539","median_amount":629.8,"10th_percentile":239.63,"90th_percentile":963.97,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"66","median_amount":642.0,"10th_percentile":255.0,"90th_percentile":910.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":131.19,"10th_percentile":51.7,"90th_percentile":151.89,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"30","median_amount":438.18,"10th_percentile":186.38,"90th_percentile":825.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"33","median_amount":498.67,"10th_percentile":186.38,"90th_percentile":936.2},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"585","median_amount":343.12,"10th_percentile":239.63,"90th_percentile":532.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"367","median_amount":269.76,"10th_percentile":239.63,"90th_percentile":509.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"50","median_amount":496.57,"10th_percentile":188.99,"90th_percentile":837.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"18","median_amount":397.3,"10th_percentile":239.63,"90th_percentile":963.91,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":416.7,"10th_percentile":416.7,"90th_percentile":416.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":637.2,"10th_percentile":333.2,"90th_percentile":1685.4,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":14.99,"10th_percentile":14.99,"90th_percentile":14.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":75.3,"10th_percentile":7.88,"90th_percentile":142.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1444.1,"10th_percentile":1444.1,"90th_percentile":1444.1},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"201","median_amount":654.0,"10th_percentile":239.63,"90th_percentile":1107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"1 through 10","median_amount":294.07,"10th_percentile":294.07,"90th_percentile":294.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"644","median_amount":215.57,"10th_percentile":186.38,"90th_percentile":414.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"135","median_amount":138.87,"10th_percentile":53.87,"90th_percentile":224.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":152.7,"10th_percentile":152.7,"90th_percentile":159.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":43.31,"10th_percentile":43.31,"90th_percentile":106.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"87","median_amount":1240.51,"10th_percentile":425.0,"90th_percentile":2813.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1705","median_amount":911.8,"10th_percentile":401.61,"90th_percentile":1187.76,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"188","median_amount":862.81,"10th_percentile":467.2,"90th_percentile":1108.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"212","median_amount":279.37,"10th_percentile":158.37,"90th_percentile":551.46,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"106","median_amount":760.87,"10th_percentile":325.15,"90th_percentile":911.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"37","median_amount":802.28,"10th_percentile":219.44,"90th_percentile":2297.7},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1016","median_amount":655.94,"10th_percentile":424.88,"90th_percentile":910.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"663","median_amount":649.15,"10th_percentile":424.87,"90th_percentile":915.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"157","median_amount":627.75,"10th_percentile":330.46,"90th_percentile":837.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":264.45,"10th_percentile":245.99,"90th_percentile":472.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":452.9,"10th_percentile":452.9,"90th_percentile":627.42,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"106","median_amount":1256.39,"10th_percentile":737.76,"90th_percentile":2459.8,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":517.37,"10th_percentile":517.37,"90th_percentile":517.37,"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":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":708.6,"10th_percentile":708.6,"90th_percentile":708.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"18","median_amount":1665.2,"10th_percentile":636.8,"90th_percentile":2098.17,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"89","median_amount":246.98,"10th_percentile":112.24,"90th_percentile":464.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":3000.82,"10th_percentile":3000.82,"90th_percentile":3000.82},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":503.73,"10th_percentile":398.39,"90th_percentile":1305.6},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":275.88,"10th_percentile":209.32,"90th_percentile":379.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"682","median_amount":969.3,"10th_percentile":307.45,"90th_percentile":1107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1038","median_amount":509.84,"10th_percentile":330.46,"90th_percentile":721.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":343.66,"10th_percentile":343.66,"90th_percentile":343.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"881","median_amount":265.53,"10th_percentile":221.01,"90th_percentile":515.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"116","median_amount":298.0,"10th_percentile":255.61,"90th_percentile":587.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":239.49,"10th_percentile":126.99,"90th_percentile":463.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"99","median_amount":3548.6,"10th_percentile":1768.56,"90th_percentile":6168.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1600","median_amount":981.96,"10th_percentile":502.0,"90th_percentile":1212.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"186","median_amount":913.83,"10th_percentile":427.2,"90th_percentile":1178.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"216","median_amount":683.75,"10th_percentile":433.02,"90th_percentile":1036.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"135","median_amount":819.9,"10th_percentile":556.0,"90th_percentile":911.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"26","median_amount":1004.73,"10th_percentile":261.11,"90th_percentile":5108.21},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"552","median_amount":1353.86,"10th_percentile":834.54,"90th_percentile":1862.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"377","median_amount":1280.24,"10th_percentile":861.3,"90th_percentile":1837.92,"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 Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"119","median_amount":648.94,"10th_percentile":504.73,"90th_percentile":837.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":704.77,"10th_percentile":513.12,"90th_percentile":839.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3295.42,"10th_percentile":3295.42,"90th_percentile":3295.42,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"98","median_amount":2272.32,"10th_percentile":1125.86,"90th_percentile":4491.46,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1657.88,"10th_percentile":1657.88,"90th_percentile":1657.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"36","median_amount":1921.95,"10th_percentile":1490.36,"90th_percentile":3297.8,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"117","median_amount":593.5,"10th_percentile":226.99,"90th_percentile":1010.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":3569.02,"10th_percentile":3569.02,"90th_percentile":3569.02},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1560.0,"10th_percentile":1425.6,"90th_percentile":3365.24},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":435.26,"10th_percentile":346.21,"90th_percentile":772.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"640","median_amount":996.3,"10th_percentile":362.05,"90th_percentile":1107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"1 through 10","median_amount":1107.0,"10th_percentile":1107.0,"90th_percentile":1107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"582","median_amount":1003.28,"10th_percentile":625.46,"90th_percentile":1422.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":725.51,"10th_percentile":613.62,"90th_percentile":893.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"975","median_amount":699.37,"10th_percentile":413.88,"90th_percentile":1028.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"138","median_amount":729.1,"10th_percentile":474.37,"90th_percentile":1118.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":614.95,"10th_percentile":495.49,"90th_percentile":802.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"35","median_amount":6446.51,"10th_percentile":2929.3,"90th_percentile":11523.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"468","median_amount":1002.0,"10th_percentile":653.88,"90th_percentile":3666.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"68","median_amount":1063.0,"10th_percentile":684.0,"90th_percentile":3314.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"122","median_amount":1133.0,"10th_percentile":680.82,"90th_percentile":2427.82,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"37","median_amount":825.0,"10th_percentile":229.47,"90th_percentile":2744.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4256.27,"10th_percentile":4069.68,"90th_percentile":9491.78},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"159","median_amount":1867.92,"10th_percentile":1178.0,"90th_percentile":3238.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"133","median_amount":1631.05,"10th_percentile":1152.95,"90th_percentile":2695.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"62","median_amount":731.96,"10th_percentile":612.75,"90th_percentile":1486.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1505.21,"10th_percentile":951.44,"90th_percentile":2747.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"25","median_amount":3944.55,"10th_percentile":2249.53,"90th_percentile":5116.14,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1753.05,"10th_percentile":1753.05,"90th_percentile":1952.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":1578.98,"10th_percentile":1308.32,"90th_percentile":2184.4,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"81","median_amount":953.35,"10th_percentile":489.73,"90th_percentile":2171.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":50.0,"10th_percentile":50.0,"90th_percentile":50.0},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1577.1,"10th_percentile":903.44,"90th_percentile":3970.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"229","median_amount":1067.0,"10th_percentile":511.15,"90th_percentile":2939.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"152","median_amount":1473.09,"10th_percentile":888.41,"90th_percentile":2365.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"475","median_amount":1066.12,"10th_percentile":656.84,"90th_percentile":2520.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"80","median_amount":1069.95,"10th_percentile":764.82,"90th_percentile":2521.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1264.45,"10th_percentile":1259.55,"90th_percentile":1351.82,"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."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":17154.49,"10th_percentile":13614.45,"90th_percentile":24257.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"41","median_amount":1187.77,"10th_percentile":801.6,"90th_percentile":4423.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2729.3,"10th_percentile":889.0,"90th_percentile":4582.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":1714.09,"10th_percentile":1207.31,"90th_percentile":2762.72,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2701.0,"10th_percentile":825.0,"90th_percentile":2709.12,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5359.2,"10th_percentile":4256.86,"90th_percentile":14567.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3902.18,"10th_percentile":3557.69,"90th_percentile":8255.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":2278.0,"10th_percentile":2278.0,"90th_percentile":2278.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1632.99,"10th_percentile":1632.99,"90th_percentile":1632.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":7464.73,"10th_percentile":7464.73,"90th_percentile":7464.73,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5303.4,"10th_percentile":5303.4,"90th_percentile":5303.4,"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":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":7168.72,"10th_percentile":7168.72,"90th_percentile":7168.72,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1293.16,"10th_percentile":1293.16,"90th_percentile":1926.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"19","median_amount":1113.75,"10th_percentile":996.3,"90th_percentile":3083.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2298.38,"10th_percentile":1469.71,"90th_percentile":5288.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"42","median_amount":1736.72,"10th_percentile":1237.92,"90th_percentile":9506.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1463.71,"10th_percentile":1145.03,"90th_percentile":2660.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"12","median_amount":899.74,"10th_percentile":441.43,"90th_percentile":1997.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"126","median_amount":910.34,"10th_percentile":401.72,"90th_percentile":1639.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"20","median_amount":632.0,"10th_percentile":348.04,"90th_percentile":1014.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":332.14,"10th_percentile":190.57,"90th_percentile":693.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"15","median_amount":604.8,"10th_percentile":263.42,"90th_percentile":1008.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":832.88,"10th_percentile":409.92,"90th_percentile":998.19},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"18","median_amount":579.96,"10th_percentile":442.58,"90th_percentile":911.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"12","median_amount":640.46,"10th_percentile":532.96,"90th_percentile":959.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"11","median_amount":1502.04,"10th_percentile":353.04,"90th_percentile":2217.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":619.06,"10th_percentile":367.62,"90th_percentile":1442.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":206.07,"10th_percentile":30.0,"90th_percentile":456.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":413.15,"10th_percentile":413.15,"90th_percentile":413.15},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":178.93,"10th_percentile":178.93,"90th_percentile":178.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"54","median_amount":954.3,"10th_percentile":319.7,"90th_percentile":1351.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"23","median_amount":417.56,"10th_percentile":379.92,"90th_percentile":865.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"101","median_amount":314.13,"10th_percentile":123.58,"90th_percentile":759.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":285.84,"10th_percentile":130.18,"90th_percentile":329.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":191.59,"10th_percentile":191.59,"90th_percentile":191.59,"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."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":1589.74,"10th_percentile":1589.74,"90th_percentile":3395.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"43","median_amount":978.48,"10th_percentile":369.6,"90th_percentile":2772.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":972.0,"10th_percentile":295.2,"90th_percentile":3392.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":474.57,"10th_percentile":321.05,"90th_percentile":630.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1008.0,"10th_percentile":1008.0,"90th_percentile":1008.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1909.38,"10th_percentile":1002.0,"90th_percentile":3410.09},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"12","median_amount":827.17,"10th_percentile":807.06,"90th_percentile":1041.13,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1135.41,"10th_percentile":823.86,"90th_percentile":4596.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1366.2,"10th_percentile":1110.5,"90th_percentile":1694.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":539.34,"10th_percentile":539.34,"90th_percentile":539.34,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":1461.55,"10th_percentile":1307.36,"90th_percentile":2400.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":1987.41,"10th_percentile":1987.41,"90th_percentile":1987.41,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":341.76,"10th_percentile":341.75,"90th_percentile":417.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":313.07,"10th_percentile":313.07,"90th_percentile":313.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"16","median_amount":1069.5,"10th_percentile":439.13,"90th_percentile":1535.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"14","median_amount":779.55,"10th_percentile":640.78,"90th_percentile":1044.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":513.61,"10th_percentile":513.61,"90th_percentile":513.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"36","median_amount":585.04,"10th_percentile":383.13,"90th_percentile":1731.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":935.74,"10th_percentile":935.74,"90th_percentile":935.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"14","median_amount":1212.0,"10th_percentile":811.63,"90th_percentile":3747.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":947.12,"10th_percentile":947.12,"90th_percentile":995.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1650.71,"10th_percentile":1650.71,"90th_percentile":1650.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":406.63,"10th_percentile":406.63,"90th_percentile":406.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1163.24,"10th_percentile":1163.24,"90th_percentile":1163.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2107.53,"10th_percentile":2107.53,"90th_percentile":2107.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":3112.08,"10th_percentile":3112.08,"90th_percentile":3112.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":814.72,"10th_percentile":736.85,"90th_percentile":1107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1560.97,"10th_percentile":1560.97,"90th_percentile":1560.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":955.22,"10th_percentile":648.84,"90th_percentile":1331.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":11619.85,"10th_percentile":11619.85,"90th_percentile":11619.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":3465.0,"10th_percentile":3465.0,"90th_percentile":4303.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1730.87,"10th_percentile":1730.87,"90th_percentile":1730.87,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3811.73,"10th_percentile":3811.73,"90th_percentile":3811.73,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":3346.0,"10th_percentile":3346.0,"90th_percentile":3346.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2699.28,"10th_percentile":2699.28,"90th_percentile":2699.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"14","median_amount":2091.49,"10th_percentile":1812.44,"90th_percentile":2879.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1764.84,"10th_percentile":1764.84,"90th_percentile":1764.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3472.99,"10th_percentile":3472.99,"90th_percentile":3472.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5671.55,"10th_percentile":5671.55,"90th_percentile":5671.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3765.07,"10th_percentile":3765.07,"90th_percentile":7603.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"11","median_amount":12139.55,"10th_percentile":5967.91,"90th_percentile":30919.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":7096.32,"10th_percentile":7096.32,"90th_percentile":7096.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5416.1,"10th_percentile":1057.92,"90th_percentile":9458.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6619.6,"10th_percentile":1909.24,"90th_percentile":9041.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":1883.74,"10th_percentile":1883.74,"90th_percentile":1883.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"14","median_amount":1774.32,"10th_percentile":801.61,"90th_percentile":2558.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3392.0,"10th_percentile":3392.0,"90th_percentile":3392.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":385.74,"10th_percentile":385.74,"90th_percentile":385.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1450.44,"10th_percentile":1155.61,"90th_percentile":1706.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1375.97,"10th_percentile":1375.97,"90th_percentile":1990.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1913.62,"10th_percentile":1913.62,"90th_percentile":1913.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2915.02,"10th_percentile":2915.02,"90th_percentile":2915.02,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":1769.85,"10th_percentile":1769.85,"90th_percentile":1769.85,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":638.07,"10th_percentile":638.07,"90th_percentile":638.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":1871.0,"10th_percentile":287.5,"90th_percentile":2709.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1133.79,"10th_percentile":1026.37,"90th_percentile":1346.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"14","median_amount":681.61,"10th_percentile":439.51,"90th_percentile":853.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":9208.43,"10th_percentile":9208.43,"90th_percentile":9208.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"52","median_amount":3465.0,"10th_percentile":2722.53,"90th_percentile":3930.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3005.06,"10th_percentile":2337.16,"90th_percentile":3761.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":1530.42,"10th_percentile":1264.92,"90th_percentile":1720.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2504.0,"10th_percentile":2504.0,"90th_percentile":2504.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3355.15,"10th_percentile":3039.84,"90th_percentile":4386.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3515.69,"10th_percentile":3515.69,"90th_percentile":3515.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":2277.0,"10th_percentile":1593.9,"90th_percentile":3038.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2187.22,"10th_percentile":2187.22,"90th_percentile":3882.33,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":3019.9,"10th_percentile":1325.0,"90th_percentile":3183.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1395.57,"10th_percentile":1263.08,"90th_percentile":1959.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"19","median_amount":2745.0,"10th_percentile":2469.71,"90th_percentile":4117.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2692.68,"10th_percentile":2145.45,"90th_percentile":5623.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"65","median_amount":1508.87,"10th_percentile":1289.6,"90th_percentile":1645.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1562.3,"10th_percentile":1562.3,"90th_percentile":1562.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1562.3,"10th_percentile":1562.3,"90th_percentile":1562.3,"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."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":16075.33,"10th_percentile":16075.33,"90th_percentile":18090.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"20","median_amount":3821.36,"10th_percentile":1154.64,"90th_percentile":5095.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3754.5,"10th_percentile":3098.0,"90th_percentile":5231.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2706.73,"10th_percentile":2455.98,"90th_percentile":2745.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3370.66,"10th_percentile":2763.2,"90th_percentile":4032.87,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4310.29,"10th_percentile":4310.29,"90th_percentile":4310.29},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5030.32,"10th_percentile":5030.32,"90th_percentile":5030.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4365.5,"10th_percentile":4365.5,"90th_percentile":4365.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":2277.0,"10th_percentile":2277.0,"90th_percentile":3415.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3863.58,"10th_percentile":3863.58,"90th_percentile":3863.58,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":7270.98,"10th_percentile":7270.98,"90th_percentile":7270.98,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2756.45,"10th_percentile":2411.39,"90th_percentile":2756.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2163.6,"10th_percentile":2163.6,"90th_percentile":2163.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":3612.33,"10th_percentile":3382.93,"90th_percentile":5602.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5824.05,"10th_percentile":5824.05,"90th_percentile":5824.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"21","median_amount":2716.93,"10th_percentile":2391.77,"90th_percentile":2745.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2642.07,"10th_percentile":2642.07,"90th_percentile":2642.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":12864.05,"10th_percentile":12864.05,"90th_percentile":12864.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"36","median_amount":3759.16,"10th_percentile":3008.8,"90th_percentile":5095.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3542.1,"10th_percentile":3098.0,"90th_percentile":4255.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3384.37,"10th_percentile":3383.68,"90th_percentile":3634.43,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3327.89,"10th_percentile":3327.89,"90th_percentile":3327.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":12437.47,"10th_percentile":12437.47,"90th_percentile":12437.47},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6130.93,"10th_percentile":6130.93,"90th_percentile":6130.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7850.95,"10th_percentile":7850.95,"90th_percentile":7850.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7371.0,"10th_percentile":7371.0,"90th_percentile":7371.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1230.0,"10th_percentile":1230.0,"90th_percentile":1230.0},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":4706.92,"10th_percentile":3046.24,"90th_percentile":4800.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6811.03,"10th_percentile":6811.03,"90th_percentile":6811.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"23","median_amount":3674.06,"10th_percentile":3246.9,"90th_percentile":6262.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":37632.15,"10th_percentile":37632.15,"90th_percentile":38631.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"16","median_amount":4823.4,"10th_percentile":3465.0,"90th_percentile":6518.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3680.0,"10th_percentile":3680.0,"90th_percentile":3680.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6216.57,"10th_percentile":6216.57,"90th_percentile":6216.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3278.19,"10th_percentile":3278.19,"90th_percentile":3278.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":22811.88,"10th_percentile":22811.88,"90th_percentile":22811.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":6604.57,"10th_percentile":3626.68,"90th_percentile":8287.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":12335.39,"10th_percentile":12335.39,"90th_percentile":12352.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6240.7,"10th_percentile":5669.95,"90th_percentile":6396.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5093","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":28444.8,"10th_percentile":28444.8,"90th_percentile":28444.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":28618.99,"10th_percentile":28618.99,"90th_percentile":28618.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":980.48,"10th_percentile":980.48,"90th_percentile":980.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12917.6,"10th_percentile":12917.6,"90th_percentile":12917.6,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":6880.0,"10th_percentile":6880.0,"90th_percentile":6880.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9067.85,"10th_percentile":9067.85,"90th_percentile":9067.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5094","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":35651.72,"10th_percentile":35651.72,"90th_percentile":35651.72,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3711.0,"10th_percentile":3711.0,"90th_percentile":3711.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23486.67,"10th_percentile":23486.67,"90th_percentile":23486.67,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":30938.62,"10th_percentile":30938.62,"90th_percentile":30938.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":140.0,"10th_percentile":140.0,"90th_percentile":140.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"48","median_amount":2129.3,"10th_percentile":570.0,"90th_percentile":4236.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":605.36,"10th_percentile":227.02,"90th_percentile":1277.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"19","median_amount":5472.0,"10th_percentile":978.0,"90th_percentile":10260.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1212.85,"10th_percentile":1212.85,"90th_percentile":1212.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1089.6,"10th_percentile":346.3,"90th_percentile":1292.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"28","median_amount":15939.0,"10th_percentile":3400.33,"90th_percentile":25047.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":16.45,"10th_percentile":16.45,"90th_percentile":16.45,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":733.5,"10th_percentile":429.68,"90th_percentile":1587.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":298.22,"10th_percentile":182.14,"90th_percentile":508.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"15","median_amount":2280.0,"10th_percentile":438.06,"90th_percentile":4158.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1001.27,"10th_percentile":273.48,"90th_percentile":2703.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":347.16,"10th_percentile":347.16,"90th_percentile":347.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"163","median_amount":539.04,"10th_percentile":134.76,"90th_percentile":1210.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":912.88,"10th_percentile":352.48,"90th_percentile":1392.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":249.76,"10th_percentile":249.76,"90th_percentile":249.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":351.93,"10th_percentile":351.93,"90th_percentile":351.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":1646.42,"10th_percentile":1646.42,"90th_percentile":1646.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":533.04,"10th_percentile":533.04,"90th_percentile":533.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1326.91,"10th_percentile":1326.91,"90th_percentile":1326.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"13","median_amount":964.5,"10th_percentile":349.31,"90th_percentile":11868.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":8875.86,"10th_percentile":8875.86,"90th_percentile":8875.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5297.88,"10th_percentile":5297.88,"90th_percentile":5297.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":585.14,"10th_percentile":538.1,"90th_percentile":1563.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":851.4,"10th_percentile":851.4,"90th_percentile":851.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":644.59,"10th_percentile":644.59,"90th_percentile":644.59,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":902.0,"10th_percentile":902.0,"90th_percentile":1107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":475.29,"10th_percentile":475.29,"90th_percentile":869.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5713.54,"10th_percentile":4450.47,"90th_percentile":6876.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":11434.07,"10th_percentile":11434.07,"90th_percentile":11434.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"30","median_amount":1212.01,"10th_percentile":863.92,"90th_percentile":5319.78,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":8331.32,"10th_percentile":8331.32,"90th_percentile":8331.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1257.19,"10th_percentile":1257.19,"90th_percentile":1257.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2328.9,"10th_percentile":2328.9,"90th_percentile":6960.87,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2591.85,"10th_percentile":2591.85,"90th_percentile":3270.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":0.72,"10th_percentile":0.72,"90th_percentile":0.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1549.57,"10th_percentile":1549.57,"90th_percentile":1549.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2160.45,"10th_percentile":2160.45,"90th_percentile":2160.45,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":2034.0,"10th_percentile":2034.0,"90th_percentile":2034.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1430.22,"10th_percentile":1430.22,"90th_percentile":1430.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":1107.0,"10th_percentile":1037.22,"90th_percentile":6744.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2368.24,"10th_percentile":1931.36,"90th_percentile":2664.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1521.7,"10th_percentile":1499.34,"90th_percentile":1541.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1527.0,"10th_percentile":1527.0,"90th_percentile":1527.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":3349.34,"10th_percentile":3349.34,"90th_percentile":3349.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"35","median_amount":5217.67,"10th_percentile":2990.45,"90th_percentile":10361.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4338.83,"10th_percentile":1820.21,"90th_percentile":8806.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2872.9,"10th_percentile":2822.9,"90th_percentile":7150.81,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4087.23,"10th_percentile":3045.0,"90th_percentile":7123.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2734.93,"10th_percentile":2734.93,"90th_percentile":2734.93},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5014.31,"10th_percentile":5014.31,"90th_percentile":5014.31,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6452.02,"10th_percentile":4993.78,"90th_percentile":7117.04,"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 Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":3261.68,"10th_percentile":2185.92,"90th_percentile":3415.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":4380.01,"10th_percentile":4380.01,"90th_percentile":4380.01,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":9075.0,"10th_percentile":9075.0,"90th_percentile":11066.31,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3157.03,"10th_percentile":3157.03,"90th_percentile":3157.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":7404.34,"10th_percentile":5154.8,"90th_percentile":8066.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3917.5,"10th_percentile":3855.61,"90th_percentile":6266.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"25","median_amount":2965.33,"10th_percentile":2729.88,"90th_percentile":6118.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3128.58,"10th_percentile":3128.58,"90th_percentile":3128.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":18722.0,"10th_percentile":18722.0,"90th_percentile":18722.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"66","median_amount":8768.78,"10th_percentile":4765.22,"90th_percentile":14372.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"15","median_amount":5418.99,"10th_percentile":2258.98,"90th_percentile":14694.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6813.41,"10th_percentile":6482.86,"90th_percentile":12340.94,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"11","median_amount":4445.83,"10th_percentile":2042.08,"90th_percentile":14464.78,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":13408.33,"10th_percentile":13408.33,"90th_percentile":26012.0},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":13082.81,"10th_percentile":11106.91,"90th_percentile":25554.27,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":15312.79,"10th_percentile":11008.81,"90th_percentile":22515.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":4224.08,"10th_percentile":3726.52,"90th_percentile":11009.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8435.98,"10th_percentile":8435.98,"90th_percentile":8435.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9643.58,"10th_percentile":9643.58,"90th_percentile":9643.58,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":8914.48,"10th_percentile":8914.48,"90th_percentile":10650.75,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":11318.83,"10th_percentile":11318.83,"90th_percentile":11318.83,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6705.12,"10th_percentile":6571.26,"90th_percentile":9006.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"26","median_amount":8849.0,"10th_percentile":4108.82,"90th_percentile":12209.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"24","median_amount":11986.35,"10th_percentile":8282.7,"90th_percentile":17455.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"49","median_amount":6852.42,"10th_percentile":5829.24,"90th_percentile":11759.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6888.88,"10th_percentile":6888.27,"90th_percentile":7285.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":41883.09,"10th_percentile":41883.09,"90th_percentile":41883.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"38","median_amount":15242.49,"10th_percentile":4791.88,"90th_percentile":21535.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":19674.48,"10th_percentile":14699.67,"90th_percentile":21662.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12346.84,"10th_percentile":12177.01,"90th_percentile":12884.39,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":13305.07,"10th_percentile":9418.27,"90th_percentile":25468.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":42688.09,"10th_percentile":42688.09,"90th_percentile":42688.09},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":19491.13,"10th_percentile":19425.34,"90th_percentile":20366.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":19484.91,"10th_percentile":19403.89,"90th_percentile":19935.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":8813.64,"10th_percentile":8110.32,"90th_percentile":12148.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":184.0,"10th_percentile":184.0,"90th_percentile":184.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":9103.93,"10th_percentile":8038.12,"90th_percentile":23339.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":16730.58,"10th_percentile":16271.18,"90th_percentile":20821.78,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10036.17,"10th_percentile":614.6,"90th_percentile":12301.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"13","median_amount":12819.88,"10th_percentile":9622.0,"90th_percentile":15011.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":15528.08,"10th_percentile":15175.59,"90th_percentile":16589.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"54","median_amount":12472.0,"10th_percentile":11382.2,"90th_percentile":12876.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12406.7,"10th_percentile":12406.7,"90th_percentile":12591.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":65474.67,"10th_percentile":65474.67,"90th_percentile":65474.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":31019.06,"10th_percentile":31019.06,"90th_percentile":31019.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":28274.12,"10th_percentile":28274.12,"90th_percentile":28274.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15828.3,"10th_percentile":15828.3,"90th_percentile":15828.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":16999.09,"10th_percentile":16999.09,"90th_percentile":17706.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":14775.72,"10th_percentile":14775.72,"90th_percentile":14775.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":43158.1,"10th_percentile":43158.1,"90th_percentile":43158.1,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":16533.31,"10th_percentile":15422.45,"90th_percentile":20077.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"19","median_amount":17768.47,"10th_percentile":16124.78,"90th_percentile":18197.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18295.36,"10th_percentile":18295.36,"90th_percentile":18295.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":1774.0,"10th_percentile":1774.0,"90th_percentile":1774.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1234.0,"10th_percentile":1234.0,"90th_percentile":1234.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":1778.0,"10th_percentile":1778.0,"90th_percentile":1778.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1195.69,"10th_percentile":1195.69,"90th_percentile":1195.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":2745.0,"10th_percentile":2745.0,"90th_percentile":2745.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2392.32,"10th_percentile":2392.32,"90th_percentile":2392.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1608.82,"10th_percentile":1326.92,"90th_percentile":1802.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":3465.0,"10th_percentile":1774.0,"90th_percentile":5575.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3268.69,"10th_percentile":3268.69,"90th_percentile":3268.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2705.33,"10th_percentile":2705.33,"90th_percentile":2705.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":6002.5,"10th_percentile":6002.5,"90th_percentile":6002.5,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":4586.64,"10th_percentile":4586.64,"90th_percentile":4586.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5321.57,"10th_percentile":5321.57,"90th_percentile":5321.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3535.57,"10th_percentile":3202.68,"90th_percentile":6368.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6802.26,"10th_percentile":6802.26,"90th_percentile":6802.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":5095.0,"10th_percentile":5095.0,"90th_percentile":5095.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3454.0,"10th_percentile":3454.0,"90th_percentile":3454.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":5453.7,"10th_percentile":5453.7,"90th_percentile":5453.7,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6625.24,"10th_percentile":6625.24,"90th_percentile":6625.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":2941.29,"10th_percentile":2941.29,"90th_percentile":3465.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":1351.0,"10th_percentile":1351.0,"90th_percentile":2695.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":3283.17,"10th_percentile":3283.17,"90th_percentile":3283.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1334.76,"10th_percentile":1334.76,"90th_percentile":1334.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":3564.8,"10th_percentile":3564.8,"90th_percentile":4076.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4581.79,"10th_percentile":4581.79,"90th_percentile":4581.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3374.62,"10th_percentile":3374.62,"90th_percentile":3374.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1424.7,"10th_percentile":1424.7,"90th_percentile":1424.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":3664.88,"10th_percentile":3664.88,"90th_percentile":4096.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4344.9,"10th_percentile":4344.9,"90th_percentile":4344.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1265.91,"10th_percentile":1265.91,"90th_percentile":1265.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":4942.15,"10th_percentile":3596.5,"90th_percentile":5053.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4434.45,"10th_percentile":4434.45,"90th_percentile":5006.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3110.53,"10th_percentile":3110.53,"90th_percentile":3110.53,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3862.95,"10th_percentile":3862.95,"90th_percentile":3862.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5238.11,"10th_percentile":5238.11,"90th_percentile":7355.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":2667.0,"10th_percentile":2667.0,"90th_percentile":2667.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":3678.0,"10th_percentile":3397.16,"90th_percentile":4890.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4039.85,"10th_percentile":3984.07,"90th_percentile":4218.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3101.92,"10th_percentile":3101.92,"90th_percentile":3101.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"12","median_amount":4845.0,"10th_percentile":4004.8,"90th_percentile":5006.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4936.6,"10th_percentile":4130.0,"90th_percentile":5006.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5635.54,"10th_percentile":5635.54,"90th_percentile":5635.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3454.0,"10th_percentile":3454.0,"90th_percentile":4255.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9166.11,"10th_percentile":8713.13,"90th_percentile":10342.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":2277.0,"10th_percentile":2277.0,"90th_percentile":2277.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":3260.2,"10th_percentile":3260.2,"90th_percentile":3260.2,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5646.07,"10th_percentile":5646.07,"90th_percentile":5646.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":4852.5,"10th_percentile":3480.0,"90th_percentile":5157.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6741.44,"10th_percentile":6741.44,"90th_percentile":6750.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5659.77,"10th_percentile":5659.77,"90th_percentile":5672.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":2383.13,"10th_percentile":2383.13,"90th_percentile":2383.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":2299.35,"10th_percentile":1264.91,"90th_percentile":2932.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":405.89,"10th_percentile":303.89,"90th_percentile":592.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2146.47,"10th_percentile":2146.47,"90th_percentile":2146.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1902.81,"10th_percentile":1902.81,"90th_percentile":1902.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1424.77,"10th_percentile":1424.77,"90th_percentile":1424.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":2599.46,"10th_percentile":2599.46,"90th_percentile":2599.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":1325.0,"10th_percentile":1325.0,"90th_percentile":1325.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":965.76,"10th_percentile":965.76,"90th_percentile":965.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":1987.96,"10th_percentile":1987.96,"90th_percentile":1987.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":665.87,"10th_percentile":537.27,"90th_percentile":2143.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":3862.25,"10th_percentile":3862.25,"90th_percentile":3862.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"11","median_amount":3120.0,"10th_percentile":1387.72,"90th_percentile":10884.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2266.78,"10th_percentile":2266.78,"90th_percentile":2266.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1489.95,"10th_percentile":1489.95,"90th_percentile":1489.95,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2695.01,"10th_percentile":2695.01,"90th_percentile":2695.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3035.96,"10th_percentile":3035.96,"90th_percentile":3035.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":2277.0,"10th_percentile":2277.0,"90th_percentile":2277.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1373.31,"10th_percentile":1373.31,"90th_percentile":1385.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":2495.2,"10th_percentile":1922.0,"90th_percentile":9079.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1882.82,"10th_percentile":1882.82,"90th_percentile":1882.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"21","median_amount":1489.66,"10th_percentile":1174.06,"90th_percentile":2981.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"25","median_amount":3911.6,"10th_percentile":3516.08,"90th_percentile":4331.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3735.58,"10th_percentile":3544.6,"90th_percentile":3911.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2980.51,"10th_percentile":2726.56,"90th_percentile":3018.86,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3235.6,"10th_percentile":3235.6,"90th_percentile":3235.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4016.0,"10th_percentile":4016.0,"90th_percentile":4016.0},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6202.15,"10th_percentile":6202.15,"90th_percentile":6202.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":2586.41,"10th_percentile":2586.41,"90th_percentile":2586.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":2496.0,"10th_percentile":2496.0,"90th_percentile":2496.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":8453.97,"10th_percentile":8453.97,"90th_percentile":8453.97,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2985.81,"10th_percentile":2877.81,"90th_percentile":3028.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4310.14,"10th_percentile":4310.14,"90th_percentile":4310.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":4273.2,"10th_percentile":4241.82,"90th_percentile":5338.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"45","median_amount":2990.68,"10th_percentile":2680.18,"90th_percentile":3118.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3034.95,"10th_percentile":3034.95,"90th_percentile":5764.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":5344.48,"10th_percentile":5344.48,"90th_percentile":5344.48,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8392.92,"10th_percentile":8392.92,"90th_percentile":8392.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":9958.88,"10th_percentile":9958.88,"90th_percentile":9958.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5576.05,"10th_percentile":5576.05,"90th_percentile":5576.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6637.81,"10th_percentile":6637.81,"90th_percentile":6637.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5183.74,"10th_percentile":5170.74,"90th_percentile":6993.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5212.39,"10th_percentile":5212.39,"90th_percentile":5212.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"11","median_amount":9665.22,"10th_percentile":8317.5,"90th_percentile":10512.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3084.95,"10th_percentile":3084.95,"90th_percentile":3203.95,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":5788.58,"10th_percentile":5788.58,"90th_percentile":5788.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9203.97,"10th_percentile":9203.97,"90th_percentile":9203.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2512.2,"10th_percentile":2512.2,"90th_percentile":2512.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":3625.87,"10th_percentile":3625.87,"90th_percentile":3625.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"14","median_amount":3084.35,"10th_percentile":3011.38,"90th_percentile":5714.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3114.78,"10th_percentile":3114.78,"90th_percentile":3114.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":13266.79,"10th_percentile":13231.79,"90th_percentile":19788.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4863.08,"10th_percentile":4863.08,"90th_percentile":6037.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":13986.0,"10th_percentile":13986.0,"90th_percentile":13986.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5185.27,"10th_percentile":5185.27,"90th_percentile":5185.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":13283.16,"10th_percentile":13283.16,"90th_percentile":13283.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"22","median_amount":5459.42,"10th_percentile":4659.25,"90th_percentile":5467.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":23278.21,"10th_percentile":23278.21,"90th_percentile":23278.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":5582.45,"10th_percentile":5004.05,"90th_percentile":7013.76,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17473.57,"10th_percentile":17473.57,"90th_percentile":23969.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":23877.7,"10th_percentile":23877.7,"90th_percentile":23877.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":19520.45,"10th_percentile":19520.45,"90th_percentile":19520.45,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10874.51,"10th_percentile":10874.51,"90th_percentile":10874.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":14610.25,"10th_percentile":14610.25,"90th_percentile":17386.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":20011.64,"10th_percentile":20011.64,"90th_percentile":20011.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"20","median_amount":10851.34,"10th_percentile":8954.73,"90th_percentile":10888.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9594.79,"10th_percentile":9594.79,"90th_percentile":9594.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":7436.78,"10th_percentile":7436.78,"90th_percentile":7436.78,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17222.82,"10th_percentile":17222.82,"90th_percentile":17222.82,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":27583.9,"10th_percentile":27583.9,"90th_percentile":27583.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":19293.2,"10th_percentile":19293.2,"90th_percentile":19293.2,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17376.44,"10th_percentile":17376.44,"90th_percentile":17376.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":16630.96,"10th_percentile":16630.96,"90th_percentile":16630.96,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7933.22,"10th_percentile":7933.22,"90th_percentile":7933.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":15935.33,"10th_percentile":15935.33,"90th_percentile":15935.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":9877.51,"10th_percentile":9877.51,"90th_percentile":9877.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7936.17,"10th_percentile":7936.17,"90th_percentile":7936.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":2840.4,"10th_percentile":2840.4,"90th_percentile":2840.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10027.64,"10th_percentile":9132.33,"90th_percentile":10042.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":9640.01,"10th_percentile":9640.01,"90th_percentile":9640.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30456.05,"10th_percentile":30456.05,"90th_percentile":30737.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":2276.14,"10th_percentile":2276.14,"90th_percentile":2276.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"17","median_amount":1647.15,"10th_percentile":1159.98,"90th_percentile":10090.1,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3326.04,"10th_percentile":1635.69,"90th_percentile":21897.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":764.71,"10th_percentile":600.35,"90th_percentile":1496.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1022.6,"10th_percentile":1022.6,"90th_percentile":1022.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":1986.22,"10th_percentile":1986.22,"90th_percentile":1986.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":837.49,"10th_percentile":737.98,"90th_percentile":2204.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":487.55,"10th_percentile":473.38,"90th_percentile":4523.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4415.02,"10th_percentile":2946.64,"90th_percentile":5625.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"33","median_amount":1004.34,"10th_percentile":600.24,"90th_percentile":2349.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":5396.12,"10th_percentile":5396.12,"90th_percentile":5396.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"35","median_amount":1614.08,"10th_percentile":1330.54,"90th_percentile":1774.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1774.0,"10th_percentile":1550.0,"90th_percentile":3465.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":899.24,"10th_percentile":860.89,"90th_percentile":1968.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1254.0,"10th_percentile":1254.0,"90th_percentile":1290.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":5827.44,"10th_percentile":5827.44,"90th_percentile":5827.44},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"16","median_amount":2037.43,"10th_percentile":1492.86,"90th_percentile":3310.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1665.26,"10th_percentile":1665.26,"90th_percentile":1665.26,"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":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1070.55,"10th_percentile":1033.0,"90th_percentile":1235.25,"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":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":5079.43,"10th_percentile":5079.43,"90th_percentile":5079.43,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":867.49,"10th_percentile":867.49,"90th_percentile":867.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":916.73,"10th_percentile":916.73,"90th_percentile":916.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":2520.0,"10th_percentile":2459.43,"90th_percentile":4726.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1380.12,"10th_percentile":1380.12,"90th_percentile":1380.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"31","median_amount":899.07,"10th_percentile":639.97,"90th_percentile":2148.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":796.03,"10th_percentile":779.53,"90th_percentile":904.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":604.03,"10th_percentile":604.03,"90th_percentile":604.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"16","median_amount":1773.97,"10th_percentile":1675.78,"90th_percentile":1774.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1774.0,"10th_percentile":1774.0,"90th_percentile":1774.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1627.65,"10th_percentile":1627.65,"90th_percentile":1627.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3631.55,"10th_percentile":3631.55,"90th_percentile":3631.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":8.47,"10th_percentile":8.47,"90th_percentile":8.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1781.04,"10th_percentile":1781.04,"90th_percentile":1781.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":3401.36,"10th_percentile":2745.0,"90th_percentile":4117.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1830.78,"10th_percentile":1830.78,"90th_percentile":1830.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"19","median_amount":1733.71,"10th_percentile":1550.95,"90th_percentile":1878.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1636.33,"10th_percentile":1636.33,"90th_percentile":1636.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1784.15,"10th_percentile":1784.15,"90th_percentile":1799.15,"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."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":1774.0,"10th_percentile":1774.0,"90th_percentile":1774.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":1713.4,"10th_percentile":1713.4,"90th_percentile":1713.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":4048.42,"10th_percentile":4038.36,"90th_percentile":5049.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"86","median_amount":1774.0,"10th_percentile":1550.0,"90th_percentile":1774.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"16","median_amount":1550.0,"10th_percentile":1501.0,"90th_percentile":1550.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1047.37,"10th_percentile":874.45,"90th_percentile":1206.81,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1254.0,"10th_percentile":1234.0,"90th_percentile":1254.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":6677.53,"10th_percentile":6677.53,"90th_percentile":6677.53},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1366.02,"10th_percentile":1353.53,"90th_percentile":2688.04,"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":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1364.4,"10th_percentile":1351.88,"90th_percentile":2825.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1647.0,"10th_percentile":1647.0,"90th_percentile":1647.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":1778.0,"10th_percentile":1778.0,"90th_percentile":1778.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":7176.97,"10th_percentile":7176.97,"90th_percentile":7822.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":925.96,"10th_percentile":876.17,"90th_percentile":1148.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"39","median_amount":2745.0,"10th_percentile":2333.24,"90th_percentile":4438.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1095.29,"10th_percentile":1050.1,"90th_percentile":1119.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"19","median_amount":874.28,"10th_percentile":874.28,"90th_percentile":1336.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":785.96,"10th_percentile":785.96,"90th_percentile":785.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":879.11,"10th_percentile":879.11,"90th_percentile":879.11,"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."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"12","median_amount":6977.12,"10th_percentile":5344.32,"90th_percentile":8916.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"117","median_amount":1774.0,"10th_percentile":1507.91,"90th_percentile":1924.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"21","median_amount":1550.0,"10th_percentile":1210.44,"90th_percentile":1749.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":1291.41,"10th_percentile":1130.89,"90th_percentile":1586.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"17","median_amount":1254.0,"10th_percentile":987.2,"90th_percentile":2319.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"15","median_amount":2815.25,"10th_percentile":1829.93,"90th_percentile":3868.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2883.98,"10th_percentile":1979.42,"90th_percentile":4027.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"12","median_amount":2058.75,"10th_percentile":1647.0,"90th_percentile":2470.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1671.27,"10th_percentile":1671.27,"90th_percentile":1671.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":2586.49,"10th_percentile":1778.0,"90th_percentile":4445.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1932.76,"10th_percentile":1932.76,"90th_percentile":1932.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":5934.68,"10th_percentile":5934.68,"90th_percentile":6425.74,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1379.16,"10th_percentile":1133.12,"90th_percentile":1583.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1421.1,"10th_percentile":1421.1,"90th_percentile":1421.1},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"46","median_amount":2745.0,"10th_percentile":2680.25,"90th_percentile":4117.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"14","median_amount":2131.32,"10th_percentile":201.27,"90th_percentile":2632.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"50","median_amount":1567.22,"10th_percentile":1130.68,"90th_percentile":2261.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2157.4,"10th_percentile":1136.92,"90th_percentile":2273.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1671.27,"10th_percentile":1671.27,"90th_percentile":1671.27,"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."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"11","median_amount":3895.26,"10th_percentile":2772.0,"90th_percentile":5036.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":152.0,"10th_percentile":152.0,"90th_percentile":152.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2364.71,"10th_percentile":2364.71,"90th_percentile":2364.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3598.16,"10th_percentile":3598.16,"90th_percentile":3598.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5848.27,"10th_percentile":5848.27,"90th_percentile":5848.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":1712.55,"10th_percentile":1712.55,"90th_percentile":1712.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":1730.92,"10th_percentile":1730.92,"90th_percentile":2196.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2883.42,"10th_percentile":2883.42,"90th_percentile":2883.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4875.1,"10th_percentile":4875.1,"90th_percentile":4875.1,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":13072.01,"10th_percentile":13072.01,"90th_percentile":13072.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"30","median_amount":5442.13,"10th_percentile":3808.88,"90th_percentile":9246.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4036.19,"10th_percentile":3769.26,"90th_percentile":6695.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":3346.47,"10th_percentile":3225.94,"90th_percentile":3346.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":5533.99,"10th_percentile":3863.08,"90th_percentile":5897.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":16501.61,"10th_percentile":16501.61,"90th_percentile":16501.61},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5584.48,"10th_percentile":5519.18,"90th_percentile":6162.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5534.93,"10th_percentile":5534.93,"90th_percentile":5534.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1803.19,"10th_percentile":1803.19,"90th_percentile":1803.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4764.0,"10th_percentile":4165.2,"90th_percentile":4764.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":2622.14,"10th_percentile":2622.14,"90th_percentile":2622.14,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5720.77,"10th_percentile":5720.77,"90th_percentile":5720.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":4272.25,"10th_percentile":4137.57,"90th_percentile":4373.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4267.55,"10th_percentile":4267.55,"90th_percentile":4267.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"30","median_amount":3340.06,"10th_percentile":2945.79,"90th_percentile":3538.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3402.86,"10th_percentile":3402.86,"90th_percentile":3402.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3103.61,"10th_percentile":3103.61,"90th_percentile":3103.61,"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."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":8968.81,"10th_percentile":7466.56,"90th_percentile":9849.4,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":9466.6,"10th_percentile":9466.6,"90th_percentile":9466.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5946.38,"10th_percentile":5946.38,"90th_percentile":5946.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":3498.4,"10th_percentile":3498.4,"90th_percentile":4814.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6136.3,"10th_percentile":6136.3,"90th_percentile":6136.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5986.62,"10th_percentile":5986.62,"90th_percentile":5986.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":21527.65,"10th_percentile":18355.08,"90th_percentile":26573.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"131","median_amount":8216.37,"10th_percentile":6429.7,"90th_percentile":8859.12,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"26","median_amount":6418.34,"10th_percentile":4280.0,"90th_percentile":8165.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5557.56,"10th_percentile":5401.74,"90th_percentile":7751.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":5384.0,"10th_percentile":2691.85,"90th_percentile":5546.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":21526.67,"10th_percentile":21526.67,"90th_percentile":21526.67},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"13","median_amount":9183.35,"10th_percentile":8651.08,"90th_percentile":12113.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":12182.05,"10th_percentile":10153.83,"90th_percentile":12850.27,"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":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":5257.0,"10th_percentile":5257.0,"90th_percentile":5257.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":8794.0,"10th_percentile":7909.0,"90th_percentile":9449.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":12954.23,"10th_percentile":12954.23,"90th_percentile":12954.23,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5652.93,"10th_percentile":5652.93,"90th_percentile":5652.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4882.51,"10th_percentile":4882.51,"90th_percentile":4882.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"57","median_amount":6100.0,"10th_percentile":4399.76,"90th_percentile":6630.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"18","median_amount":7218.29,"10th_percentile":6754.34,"90th_percentile":8657.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"38","median_amount":5552.63,"10th_percentile":4921.64,"90th_percentile":5983.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5627.72,"10th_percentile":5627.72,"90th_percentile":6022.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":60164.24,"10th_percentile":60164.24,"90th_percentile":60164.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"16","median_amount":8455.63,"10th_percentile":7007.51,"90th_percentile":8846.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":6649.6,"10th_percentile":6284.02,"90th_percentile":9268.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4367.2,"10th_percentile":4367.2,"90th_percentile":4367.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":10581.15,"10th_percentile":10581.15,"90th_percentile":10581.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":5340.0,"10th_percentile":5340.0,"90th_percentile":6846.14,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9806.38,"10th_percentile":9806.38,"90th_percentile":9806.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":11052.34,"10th_percentile":5999.17,"90th_percentile":13313.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":13178.93,"10th_percentile":12545.29,"90th_percentile":13344.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9694.65,"10th_percentile":9694.65,"90th_percentile":10327.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10429.93,"10th_percentile":10429.93,"90th_percentile":10429.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":855.49,"10th_percentile":855.49,"90th_percentile":855.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":233.27,"10th_percentile":233.27,"90th_percentile":233.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":233.73,"10th_percentile":233.73,"90th_percentile":233.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":1645.67,"10th_percentile":1645.67,"90th_percentile":1645.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":479.25,"10th_percentile":479.25,"90th_percentile":479.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":373.88,"10th_percentile":373.88,"90th_percentile":434.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":566.66,"10th_percentile":566.66,"90th_percentile":566.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":8810.7,"10th_percentile":8770.27,"90th_percentile":8951.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"53","median_amount":3413.02,"10th_percentile":2772.0,"90th_percentile":3761.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3392.0,"10th_percentile":3098.0,"90th_percentile":3651.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":1926.44,"10th_percentile":1705.22,"90th_percentile":2004.89,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2593.24,"10th_percentile":2593.24,"90th_percentile":2789.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3022.68,"10th_percentile":3017.75,"90th_percentile":6015.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"38","median_amount":3721.05,"10th_percentile":2452.18,"90th_percentile":4093.19,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":2477.77,"10th_percentile":2477.77,"90th_percentile":2577.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":9241.55,"10th_percentile":9241.55,"90th_percentile":9241.55,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1929.66,"10th_percentile":1751.21,"90th_percentile":2969.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1665.0,"10th_percentile":1665.0,"90th_percentile":1665.0},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"26","median_amount":2957.0,"10th_percentile":2016.71,"90th_percentile":3247.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":1703.59,"10th_percentile":1703.59,"90th_percentile":1703.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"75","median_amount":1919.56,"10th_percentile":1728.94,"90th_percentile":2121.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1975.26,"10th_percentile":1975.26,"90th_percentile":1975.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":17875.43,"10th_percentile":9613.25,"90th_percentile":23624.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"133","median_amount":9602.0,"10th_percentile":7187.7,"90th_percentile":10247.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":8667.48,"10th_percentile":7170.27,"90th_percentile":9602.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":3224.29,"10th_percentile":2982.04,"90th_percentile":3481.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":6972.0,"10th_percentile":3711.0,"90th_percentile":7084.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":22969.15,"10th_percentile":22969.15,"90th_percentile":22969.15},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":7026.19,"10th_percentile":5443.47,"90th_percentile":10029.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":5110.0,"10th_percentile":2555.0,"90th_percentile":6248.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"29","median_amount":4655.88,"10th_percentile":4197.1,"90th_percentile":4655.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"18","median_amount":10364.0,"10th_percentile":5218.21,"90th_percentile":11671.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":14941.41,"10th_percentile":14941.41,"90th_percentile":15301.63,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3314.53,"10th_percentile":3020.53,"90th_percentile":6796.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"74","median_amount":9580.89,"10th_percentile":8293.4,"90th_percentile":10643.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6438.37,"10th_percentile":5210.45,"90th_percentile":6700.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"108","median_amount":3294.36,"10th_percentile":2943.11,"90th_percentile":3463.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2098.55,"10th_percentile":2098.55,"90th_percentile":2098.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"15","median_amount":5044.05,"10th_percentile":4400.37,"90th_percentile":9602.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4389.06,"10th_percentile":4389.06,"90th_percentile":4875.85,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":7060.85,"10th_percentile":7060.85,"90th_percentile":7060.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":12929.36,"10th_percentile":12929.36,"90th_percentile":12929.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":6862.56,"10th_percentile":6229.57,"90th_percentile":6862.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":15704.0,"10th_percentile":15704.0,"90th_percentile":15706.42,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4846.46,"10th_percentile":4846.46,"90th_percentile":6414.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":10086.08,"10th_percentile":5246.0,"90th_percentile":13362.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"35","median_amount":4861.9,"10th_percentile":4412.24,"90th_percentile":5031.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":5006.0,"10th_percentile":5006.0,"90th_percentile":5006.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":1497.43,"10th_percentile":1497.43,"90th_percentile":1497.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"22","median_amount":1173.59,"10th_percentile":336.72,"90th_percentile":1284.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":136.99,"10th_percentile":136.99,"90th_percentile":136.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":945.36,"10th_percentile":945.36,"90th_percentile":945.36,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":312.35,"10th_percentile":291.96,"90th_percentile":312.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":506.45,"10th_percentile":506.45,"90th_percentile":669.04,"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 Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":1789.91,"10th_percentile":1789.91,"90th_percentile":1789.91,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":770.42,"10th_percentile":399.0,"90th_percentile":990.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"11","median_amount":396.74,"10th_percentile":380.56,"90th_percentile":517.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":801.6,"10th_percentile":801.6,"90th_percentile":1068.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":775.65,"10th_percentile":775.65,"90th_percentile":775.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":968.47,"10th_percentile":968.47,"90th_percentile":1107.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":2009.74,"10th_percentile":2009.74,"90th_percentile":2009.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":212.5,"10th_percentile":212.5,"90th_percentile":212.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":526.38,"10th_percentile":526.38,"90th_percentile":526.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":414.25,"10th_percentile":414.25,"90th_percentile":414.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"17","median_amount":4951.4,"10th_percentile":3505.44,"90th_percentile":8669.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":6608.4,"10th_percentile":6608.4,"90th_percentile":6608.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3158.0,"10th_percentile":3158.0,"90th_percentile":3158.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4898.92,"10th_percentile":4898.92,"90th_percentile":4898.92,"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":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":5554.83,"10th_percentile":5554.83,"90th_percentile":5554.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":5257.0,"10th_percentile":5257.0,"90th_percentile":5257.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":1325.0,"10th_percentile":1325.0,"90th_percentile":1325.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":5497.79,"10th_percentile":5497.79,"90th_percentile":5497.79,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":3563.92,"10th_percentile":3518.13,"90th_percentile":6956.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4170.81,"10th_percentile":4170.81,"90th_percentile":5491.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":27862.81,"10th_percentile":27862.81,"90th_percentile":27862.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"14","median_amount":5073.07,"10th_percentile":4076.0,"90th_percentile":7593.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4123.34,"10th_percentile":4123.34,"90th_percentile":4123.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":5281.05,"10th_percentile":5281.05,"90th_percentile":5281.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4705.62,"10th_percentile":4705.62,"90th_percentile":4705.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":7423.04,"10th_percentile":4264.25,"90th_percentile":10305.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":6461.48,"10th_percentile":6461.48,"90th_percentile":6461.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4745.67,"10th_percentile":4745.67,"90th_percentile":4745.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":4964.27,"10th_percentile":4964.27,"90th_percentile":4964.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7024.73,"10th_percentile":7024.73,"90th_percentile":7024.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":7802.58,"10th_percentile":7802.58,"90th_percentile":7802.58,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":9966.02,"10th_percentile":9966.02,"90th_percentile":9966.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":21529.05,"10th_percentile":21529.05,"90th_percentile":21529.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"14","median_amount":5006.0,"10th_percentile":3465.0,"90th_percentile":9695.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":9524.14,"10th_percentile":9524.14,"90th_percentile":9524.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1693.86,"10th_percentile":1693.86,"90th_percentile":1834.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2504.0,"10th_percentile":2504.0,"90th_percentile":2723.78,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":587.84,"10th_percentile":578.26,"90th_percentile":596.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":566.93,"10th_percentile":566.93,"90th_percentile":566.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":3331.5,"10th_percentile":3331.5,"90th_percentile":3331.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2636.12,"10th_percentile":2636.12,"90th_percentile":2636.12,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":1835.44,"10th_percentile":1835.44,"90th_percentile":1835.44,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2240.7,"10th_percentile":2240.7,"90th_percentile":2240.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":7855.66,"10th_percentile":7855.66,"90th_percentile":7855.66,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1615.84,"10th_percentile":1615.84,"90th_percentile":1615.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"11","median_amount":4052.75,"10th_percentile":1036.0,"90th_percentile":7981.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"12","median_amount":781.12,"10th_percentile":578.26,"90th_percentile":2246.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"21","median_amount":1859.6,"10th_percentile":1784.7,"90th_percentile":5852.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1882.94,"10th_percentile":1882.94,"90th_percentile":1882.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Procedures","code_information":[{"code":"5432","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":12863.91,"10th_percentile":12863.91,"90th_percentile":12863.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":14556.61,"10th_percentile":14556.61,"90th_percentile":14556.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":1129.5,"10th_percentile":1064.17,"90th_percentile":3761.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1500.86,"10th_percentile":1500.86,"90th_percentile":1500.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":209.36,"10th_percentile":209.36,"90th_percentile":416.81,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"55","median_amount":324.52,"10th_percentile":85.5,"90th_percentile":852.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"31","median_amount":408.08,"10th_percentile":91.61,"90th_percentile":695.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":627.75,"10th_percentile":627.75,"90th_percentile":627.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":931.07,"10th_percentile":931.07,"90th_percentile":931.07,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":1107.0,"10th_percentile":162.8,"90th_percentile":2729.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"47","median_amount":359.9,"10th_percentile":220.96,"90th_percentile":610.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"18","median_amount":350.4,"10th_percentile":259.96,"90th_percentile":535.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":408.89,"10th_percentile":408.89,"90th_percentile":408.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":3028.8,"10th_percentile":241.18,"90th_percentile":3639.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":625.87,"10th_percentile":625.87,"90th_percentile":625.87,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2611.18,"10th_percentile":2611.18,"90th_percentile":2611.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"85","median_amount":486.61,"10th_percentile":9.62,"90th_percentile":613.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"46","median_amount":477.15,"10th_percentile":9.58,"90th_percentile":605.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":2934.74,"10th_percentile":2934.74,"90th_percentile":2934.74,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":439.89,"10th_percentile":347.03,"90th_percentile":620.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":1113.21,"10th_percentile":807.0,"90th_percentile":1922.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"98","median_amount":487.08,"10th_percentile":6.11,"90th_percentile":529.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":625.74,"10th_percentile":553.08,"90th_percentile":1596.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":667.76,"10th_percentile":667.76,"90th_percentile":667.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":1451.65,"10th_percentile":1451.65,"90th_percentile":1451.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":813.82,"10th_percentile":813.82,"90th_percentile":813.82,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":255.6,"10th_percentile":228.37,"90th_percentile":1357.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":226.75,"10th_percentile":223.89,"90th_percentile":226.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":3331.5,"10th_percentile":2615.58,"90th_percentile":3415.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":1590.0,"10th_percentile":1590.0,"90th_percentile":1590.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":118.04,"10th_percentile":118.04,"90th_percentile":118.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2590.41,"10th_percentile":1487.46,"90th_percentile":2623.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"18","median_amount":255.6,"10th_percentile":228.37,"90th_percentile":1033.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"11","median_amount":1631.61,"10th_percentile":808.89,"90th_percentile":2507.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1410.89,"10th_percentile":1410.89,"90th_percentile":1410.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":16621.03,"10th_percentile":16621.03,"90th_percentile":19317.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2877.23,"10th_percentile":2877.23,"90th_percentile":2877.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3008.71,"10th_percentile":3008.71,"90th_percentile":3297.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":15052.94,"10th_percentile":15052.94,"90th_percentile":20459.45,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11663.17,"10th_percentile":6328.21,"90th_percentile":11931.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":15048.03,"10th_percentile":15048.03,"90th_percentile":15048.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":9843.22,"10th_percentile":9843.22,"90th_percentile":9843.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":16243.3,"10th_percentile":16243.3,"90th_percentile":16243.3,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11930.2,"10th_percentile":11930.2,"90th_percentile":11930.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"12","median_amount":6253.14,"10th_percentile":5955.34,"90th_percentile":6495.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":35950.36,"10th_percentile":35950.36,"90th_percentile":39712.76,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20529.6,"10th_percentile":20529.6,"90th_percentile":20529.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20537.48,"10th_percentile":20537.48,"90th_percentile":20537.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":1136.45,"10th_percentile":1136.45,"90th_percentile":1136.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"13","median_amount":20525.55,"10th_percentile":18695.53,"90th_percentile":20563.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18828.41,"10th_percentile":18828.41,"90th_percentile":18828.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":35675.08,"10th_percentile":35675.08,"90th_percentile":35675.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":32578.42,"10th_percentile":32578.42,"90th_percentile":33524.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":14134.2,"10th_percentile":14134.2,"90th_percentile":14134.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28939.02,"10th_percentile":27856.18,"90th_percentile":29383.85,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":21921.14,"10th_percentile":21921.14,"90th_percentile":21921.14,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":26620.21,"10th_percentile":26620.21,"90th_percentile":27911.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29177.51,"10th_percentile":29177.51,"90th_percentile":30216.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5502","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":852.87,"10th_percentile":852.87,"90th_percentile":852.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5503","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. 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Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2132.15,"10th_percentile":2132.15,"90th_percentile":2132.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"48","median_amount":417.0,"10th_percentile":152.8,"90th_percentile":861.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1023","median_amount":331.45,"10th_percentile":63.14,"90th_percentile":780.78,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"122","median_amount":333.23,"10th_percentile":53.98,"90th_percentile":705.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"93","median_amount":80.48,"10th_percentile":59.95,"90th_percentile":354.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"61","median_amount":370.8,"10th_percentile":48.85,"90th_percentile":825.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"48","median_amount":423.0,"10th_percentile":85.35,"90th_percentile":1039.41},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"271","median_amount":326.81,"10th_percentile":133.13,"90th_percentile":967.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"173","median_amount":326.81,"10th_percentile":133.13,"90th_percentile":753.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"77","median_amount":116.0,"10th_percentile":87.0,"90th_percentile":423.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":75.38,"10th_percentile":75.38,"90th_percentile":75.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":118.86,"10th_percentile":118.86,"90th_percentile":118.86,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"67","median_amount":321.04,"10th_percentile":223.72,"90th_percentile":697.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":339.3,"10th_percentile":278.46,"90th_percentile":1183.75,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"40","median_amount":86.34,"10th_percentile":67.69,"90th_percentile":278.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":264.33,"10th_percentile":75.0,"90th_percentile":450.08},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":83.2,"10th_percentile":83.2,"90th_percentile":83.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"394","median_amount":364.06,"10th_percentile":161.64,"90th_percentile":634.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"1 through 10","median_amount":526.0,"10th_percentile":526.0,"90th_percentile":526.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"243","median_amount":254.18,"10th_percentile":103.54,"90th_percentile":819.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":84.94,"10th_percentile":84.94,"90th_percentile":84.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"422","median_amount":84.94,"10th_percentile":75.06,"90th_percentile":265.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":209.16,"10th_percentile":84.9,"90th_percentile":638.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":124.26,"10th_percentile":34.9,"90th_percentile":215.44,"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."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"60","median_amount":562.02,"10th_percentile":102.54,"90th_percentile":963.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"826","median_amount":309.98,"10th_percentile":102.71,"90th_percentile":785.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"105","median_amount":240.57,"10th_percentile":82.37,"90th_percentile":732.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"170","median_amount":102.0,"10th_percentile":77.5,"90th_percentile":250.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"67","median_amount":239.38,"10th_percentile":89.49,"90th_percentile":509.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"22","median_amount":364.2,"10th_percentile":114.12,"90th_percentile":1012.32},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"191","median_amount":163.19,"10th_percentile":161.08,"90th_percentile":404.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"103","median_amount":163.19,"10th_percentile":161.08,"90th_percentile":437.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"105","median_amount":237.26,"10th_percentile":116.0,"90th_percentile":787.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":92.65,"10th_percentile":92.65,"90th_percentile":112.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":143.56,"10th_percentile":143.56,"90th_percentile":143.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"52","median_amount":588.91,"10th_percentile":228.14,"90th_percentile":857.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":105.52,"10th_percentile":105.52,"90th_percentile":105.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":502.7,"10th_percentile":454.1,"90th_percentile":794.99,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":93.85,"10th_percentile":93.85,"90th_percentile":93.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"86","median_amount":104.28,"10th_percentile":86.53,"90th_percentile":350.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":40.0,"10th_percentile":40.0,"90th_percentile":40.0},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":340.96,"10th_percentile":229.75,"90th_percentile":2696.4},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":80.39,"10th_percentile":80.39,"90th_percentile":80.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"313","median_amount":245.18,"10th_percentile":182.03,"90th_percentile":565.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"1 through 10","median_amount":245.18,"10th_percentile":245.18,"90th_percentile":245.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"170","median_amount":126.92,"10th_percentile":125.29,"90th_percentile":340.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"690","median_amount":101.98,"10th_percentile":88.44,"90th_percentile":198.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"64","median_amount":102.54,"10th_percentile":94.54,"90th_percentile":189.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":102.54,"10th_percentile":94.54,"90th_percentile":160.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"22","median_amount":1329.81,"10th_percentile":656.65,"90th_percentile":2076.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"248","median_amount":944.98,"10th_percentile":538.66,"90th_percentile":1501.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"55","median_amount":816.76,"10th_percentile":485.0,"90th_percentile":1518.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"100","median_amount":210.46,"10th_percentile":40.75,"90th_percentile":402.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"31","median_amount":672.47,"10th_percentile":69.81,"90th_percentile":1005.33,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1287.36,"10th_percentile":1076.49,"90th_percentile":3218.4},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"80","median_amount":359.01,"10th_percentile":359.01,"90th_percentile":538.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"49","median_amount":370.91,"10th_percentile":359.01,"90th_percentile":538.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"48","median_amount":786.0,"10th_percentile":537.0,"90th_percentile":1048.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":181.41,"10th_percentile":181.41,"90th_percentile":181.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":295.01,"10th_percentile":295.01,"90th_percentile":326.31,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"25","median_amount":1004.86,"10th_percentile":765.65,"90th_percentile":1525.18,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":237.44,"10th_percentile":237.44,"90th_percentile":237.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":277.37,"10th_percentile":277.37,"90th_percentile":277.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":1298.05,"10th_percentile":547.13,"90th_percentile":1736.86,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"44","median_amount":214.3,"10th_percentile":185.84,"90th_percentile":395.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":279.7,"10th_percentile":279.7,"90th_percentile":279.7},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1150.0,"10th_percentile":377.59,"90th_percentile":1180.08},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":182.73,"10th_percentile":182.73,"90th_percentile":182.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"126","median_amount":487.0,"10th_percentile":359.01,"90th_percentile":828.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"86","median_amount":288.48,"10th_percentile":279.23,"90th_percentile":558.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":231.8,"10th_percentile":220.92,"90th_percentile":411.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"364","median_amount":227.9,"10th_percentile":136.07,"90th_percentile":352.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"79","median_amount":233.08,"10th_percentile":210.72,"90th_percentile":520.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":186.46,"10th_percentile":182.73,"90th_percentile":198.12,"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."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":1837.08,"10th_percentile":1661.77,"90th_percentile":2133.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"114","median_amount":1039.0,"10th_percentile":710.04,"90th_percentile":2517.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"20","median_amount":877.0,"10th_percentile":376.2,"90th_percentile":1870.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":525.89,"10th_percentile":285.79,"90th_percentile":750.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1680.0,"10th_percentile":877.0,"90th_percentile":2968.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":354.6,"10th_percentile":354.6,"90th_percentile":354.6},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":841.36,"10th_percentile":808.29,"90th_percentile":1375.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":841.36,"10th_percentile":808.29,"90th_percentile":1660.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":284.0,"10th_percentile":198.8,"90th_percentile":3417.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":2343.8,"10th_percentile":1571.64,"90th_percentile":2913.66,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":514.93,"10th_percentile":281.43,"90th_percentile":665.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1414.35,"10th_percentile":1414.35,"90th_percentile":1414.35},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"28","median_amount":239.0,"10th_percentile":203.15,"90th_percentile":1084.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"13","median_amount":654.39,"10th_percentile":628.67,"90th_percentile":1397.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"51","median_amount":526.38,"10th_percentile":469.41,"90th_percentile":755.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":528.69,"10th_percentile":506.16,"90th_percentile":793.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":469.12,"10th_percentile":469.12,"90th_percentile":739.01,"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."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":1260.3,"10th_percentile":705.42,"90th_percentile":4762.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"75","median_amount":783.32,"10th_percentile":445.34,"90th_percentile":1579.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"11","median_amount":388.51,"10th_percentile":178.42,"90th_percentile":734.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":251.11,"10th_percentile":156.8,"90th_percentile":1219.97,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"13","median_amount":562.7,"10th_percentile":396.75,"90th_percentile":1266.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":766.2,"10th_percentile":766.2,"90th_percentile":766.2},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"15","median_amount":364.3,"10th_percentile":269.21,"90th_percentile":951.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":281.47,"10th_percentile":269.21,"90th_percentile":2806.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"17","median_amount":629.28,"10th_percentile":124.84,"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":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1152.92,"10th_percentile":1152.92,"90th_percentile":1152.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":831.71,"10th_percentile":607.9,"90th_percentile":1504.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":1241.62,"10th_percentile":1241.62,"90th_percentile":1241.62,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":297.5,"10th_percentile":120.17,"90th_percentile":981.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":40.0,"10th_percentile":40.0,"90th_percentile":40.0},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":91.79,"10th_percentile":91.79,"90th_percentile":91.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"46","median_amount":417.76,"10th_percentile":325.08,"90th_percentile":1107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"20","median_amount":654.09,"10th_percentile":209.38,"90th_percentile":2125.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"116","median_amount":187.0,"10th_percentile":153.0,"90th_percentile":982.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":274.19,"10th_percentile":164.34,"90th_percentile":1535.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":255.09,"10th_percentile":255.09,"90th_percentile":255.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"22","median_amount":2441.42,"10th_percentile":920.0,"90th_percentile":3448.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"261","median_amount":1142.37,"10th_percentile":711.4,"90th_percentile":1860.78,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"37","median_amount":934.0,"10th_percentile":463.37,"90th_percentile":2400.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"66","median_amount":328.97,"10th_percentile":151.44,"90th_percentile":612.78,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"17","median_amount":824.56,"10th_percentile":488.75,"90th_percentile":1375.53,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2256.91,"10th_percentile":2256.91,"90th_percentile":2993.79},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"50","median_amount":723.34,"10th_percentile":548.01,"90th_percentile":1406.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"24","median_amount":563.47,"10th_percentile":548.01,"90th_percentile":1050.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"13","median_amount":803.03,"10th_percentile":627.75,"90th_percentile":1612.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":516.01,"10th_percentile":516.01,"90th_percentile":516.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"40","median_amount":482.1,"10th_percentile":463.01,"90th_percentile":482.1,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"21","median_amount":1532.46,"10th_percentile":493.57,"90th_percentile":2893.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1742.3,"10th_percentile":1742.3,"90th_percentile":1742.3,"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":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":1647.0,"10th_percentile":1526.69,"90th_percentile":2047.1,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"26","median_amount":315.19,"10th_percentile":290.61,"90th_percentile":838.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":425.0,"10th_percentile":425.0,"90th_percentile":425.0},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"118","median_amount":807.9,"10th_percentile":539.0,"90th_percentile":1107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"46","median_amount":459.35,"10th_percentile":426.23,"90th_percentile":1148.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":311.3,"10th_percentile":311.3,"90th_percentile":311.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"267","median_amount":338.58,"10th_percentile":266.08,"90th_percentile":657.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"54","median_amount":344.36,"10th_percentile":330.72,"90th_percentile":824.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":259.29,"10th_percentile":259.29,"90th_percentile":486.35,"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."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":10507.75,"10th_percentile":10507.75,"90th_percentile":10507.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":2752.96,"10th_percentile":831.2,"90th_percentile":3611.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3354.07,"10th_percentile":3354.07,"90th_percentile":3354.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":974.62,"10th_percentile":974.62,"90th_percentile":974.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1998.0,"10th_percentile":1998.0,"90th_percentile":1998.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1736.6,"10th_percentile":1736.6,"90th_percentile":1736.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1760.33,"10th_percentile":1760.33,"90th_percentile":1760.33,"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":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":2454.11,"10th_percentile":2454.11,"90th_percentile":2454.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":946.71,"10th_percentile":946.71,"90th_percentile":946.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":1135.1,"10th_percentile":403.75,"90th_percentile":1323.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":927.26,"10th_percentile":819.23,"90th_percentile":1038.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":790.14,"10th_percentile":790.14,"90th_percentile":790.14,"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."}]}]},{"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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"12","median_amount":805.03,"10th_percentile":710.9,"90th_percentile":1224.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":926.22,"10th_percentile":926.22,"90th_percentile":926.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":741.79,"10th_percentile":741.79,"90th_percentile":741.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":554.66,"10th_percentile":554.66,"90th_percentile":554.66,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":632.79,"10th_percentile":632.79,"90th_percentile":632.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":781.58,"10th_percentile":781.58,"90th_percentile":781.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":531.0,"10th_percentile":531.0,"90th_percentile":531.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":897.18,"10th_percentile":897.18,"90th_percentile":897.18,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":978.13,"10th_percentile":846.33,"90th_percentile":1104.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":597.25,"10th_percentile":597.25,"90th_percentile":597.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":391.3,"10th_percentile":316.22,"90th_percentile":737.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":1329.26,"10th_percentile":1329.26,"90th_percentile":1329.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"11","median_amount":1001.99,"10th_percentile":344.72,"90th_percentile":1083.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1056.73,"10th_percentile":710.85,"90th_percentile":1270.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1317.0,"10th_percentile":1317.0,"90th_percentile":1317.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":655.0,"10th_percentile":655.0,"90th_percentile":788.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1017.41,"10th_percentile":1017.41,"90th_percentile":1017.41},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":842.15,"10th_percentile":842.15,"90th_percentile":842.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":708.0,"10th_percentile":708.0,"90th_percentile":708.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":1014.65,"10th_percentile":1014.65,"90th_percentile":1014.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":807.06,"10th_percentile":807.06,"90th_percentile":807.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":1085.36,"10th_percentile":340.0,"90th_percentile":1111.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":628.56,"10th_percentile":628.56,"90th_percentile":628.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":503.21,"10th_percentile":330.12,"90th_percentile":1148.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":4983.69,"10th_percentile":4983.69,"90th_percentile":9710.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"61","median_amount":2435.08,"10th_percentile":1349.53,"90th_percentile":3016.89,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2554.02,"10th_percentile":2554.02,"90th_percentile":2554.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":1272.02,"10th_percentile":1128.08,"90th_percentile":1802.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2545.55,"10th_percentile":2545.55,"90th_percentile":3499.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2782.87,"10th_percentile":2782.87,"90th_percentile":3453.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1174.8,"10th_percentile":1174.8,"90th_percentile":1174.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":4530.86,"10th_percentile":4530.86,"90th_percentile":4558.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":4733.11,"10th_percentile":4733.11,"90th_percentile":4949.89,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":943.86,"10th_percentile":943.86,"90th_percentile":1243.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":2303.99,"10th_percentile":2303.99,"90th_percentile":2303.99},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"26","median_amount":3449.07,"10th_percentile":1848.28,"90th_percentile":3787.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2055.85,"10th_percentile":2055.85,"90th_percentile":2948.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"40","median_amount":1267.89,"10th_percentile":1182.39,"90th_percentile":1713.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1241.1,"10th_percentile":1241.1,"90th_percentile":1278.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"16","median_amount":3208.64,"10th_percentile":2587.81,"90th_percentile":3957.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2967.97,"10th_percentile":2967.97,"90th_percentile":2967.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1275.41,"10th_percentile":1207.88,"90th_percentile":1398.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2292.17,"10th_percentile":2292.17,"90th_percentile":2292.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":9865.13,"10th_percentile":9865.13,"90th_percentile":9865.13,"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":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3734.5,"10th_percentile":3734.5,"90th_percentile":3734.5,"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":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1340.87,"10th_percentile":1340.87,"90th_percentile":1360.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":3330.77,"10th_percentile":2118.63,"90th_percentile":6372.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1740.79,"10th_percentile":1740.79,"90th_percentile":1740.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"30","median_amount":1394.81,"10th_percentile":1333.04,"90th_percentile":1624.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4398.39,"10th_percentile":1406.43,"90th_percentile":4398.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1106.43,"10th_percentile":1106.43,"90th_percentile":1106.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":19932.97,"10th_percentile":832.65,"90th_percentile":30137.05,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":33272.4,"10th_percentile":33272.4,"90th_percentile":33272.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":20582.24,"10th_percentile":20582.24,"90th_percentile":20582.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1123.46,"10th_percentile":1123.46,"90th_percentile":1123.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":835.38,"10th_percentile":835.38,"90th_percentile":835.38,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":348.6,"10th_percentile":348.6,"90th_percentile":348.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":9130.25,"10th_percentile":9130.25,"90th_percentile":9130.25},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":11250.0,"10th_percentile":11250.0,"90th_percentile":11250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"20","median_amount":632.02,"10th_percentile":281.85,"90th_percentile":7922.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8448.04,"10th_percentile":8448.04,"90th_percentile":8448.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":27594.57,"10th_percentile":27594.57,"90th_percentile":27594.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2981.39,"10th_percentile":2981.39,"90th_percentile":3603.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":7827.91,"10th_percentile":7827.91,"90th_percentile":7827.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4051.9,"10th_percentile":4051.9,"90th_percentile":4051.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9221.86,"10th_percentile":9221.86,"90th_percentile":9221.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2957.21,"10th_percentile":2957.21,"90th_percentile":2957.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":7080.0,"10th_percentile":7080.0,"90th_percentile":7080.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3755.94,"10th_percentile":2405.76,"90th_percentile":4484.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2839.11,"10th_percentile":2839.11,"90th_percentile":2839.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Radiation Therapy","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"14","median_amount":19754.24,"10th_percentile":11530.2,"90th_percentile":23696.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":17326.81,"10th_percentile":17326.81,"90th_percentile":17326.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7517.02,"10th_percentile":7517.02,"90th_percentile":9360.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":20246.24,"10th_percentile":20246.24,"90th_percentile":20246.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5339.19,"10th_percentile":5339.19,"90th_percentile":6186.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":6996.12,"10th_percentile":6996.12,"90th_percentile":6996.12},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":15930.0,"10th_percentile":2950.0,"90th_percentile":24780.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"24","median_amount":3658.97,"10th_percentile":1263.4,"90th_percentile":6195.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5431.12,"10th_percentile":5431.12,"90th_percentile":5431.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"16","median_amount":20266.64,"10th_percentile":3202.5,"90th_percentile":33845.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":7065.38,"10th_percentile":2901.49,"90th_percentile":12016.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":21415.52,"10th_percentile":21415.52,"90th_percentile":28442.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":21381.94,"10th_percentile":21381.94,"90th_percentile":21381.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":25923.7,"10th_percentile":25923.7,"90th_percentile":25923.7,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8899.1,"10th_percentile":8372.23,"90th_percentile":11494.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":7670.0,"10th_percentile":1180.0,"90th_percentile":20650.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":19479.05,"10th_percentile":19479.05,"90th_percentile":19479.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"46","median_amount":8403.19,"10th_percentile":1236.76,"90th_percentile":12171.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":8878.78,"10th_percentile":6949.4,"90th_percentile":12353.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Radiation Therapy","code_information":[{"code":"5626","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":47057.84,"10th_percentile":47057.84,"90th_percentile":47057.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11505.55,"10th_percentile":11505.55,"90th_percentile":11505.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":44622.2,"10th_percentile":44622.2,"90th_percentile":44622.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":10620.0,"10th_percentile":10620.0,"90th_percentile":10620.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10094.29,"10th_percentile":9251.59,"90th_percentile":12509.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9867.64,"10th_percentile":9648.35,"90th_percentile":10472.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":120.28,"10th_percentile":120.28,"90th_percentile":120.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":50.71,"10th_percentile":50.71,"90th_percentile":50.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":51.24,"10th_percentile":51.24,"90th_percentile":51.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":53.97,"10th_percentile":53.97,"90th_percentile":53.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":81.99,"10th_percentile":81.99,"90th_percentile":81.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":77.11,"10th_percentile":77.11,"90th_percentile":77.11,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":51.35,"10th_percentile":51.35,"90th_percentile":51.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":44.78,"10th_percentile":44.78,"90th_percentile":77.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":51.24,"10th_percentile":51.24,"90th_percentile":76.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":1163.68,"10th_percentile":1163.68,"90th_percentile":1163.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":1064.88,"10th_percentile":1064.88,"90th_percentile":1064.88,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":1561.91,"10th_percentile":1561.91,"90th_percentile":2144.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2687.61,"10th_percentile":2687.61,"90th_percentile":2687.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1775.18,"10th_percentile":1775.18,"90th_percentile":1775.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":796.41,"10th_percentile":796.41,"90th_percentile":796.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1508.3,"10th_percentile":1508.3,"90th_percentile":1508.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":1149.66,"10th_percentile":1149.66,"90th_percentile":1149.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":2765.96,"10th_percentile":2765.96,"90th_percentile":2765.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1345.03,"10th_percentile":1345.03,"90th_percentile":1345.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":4682.04,"10th_percentile":4682.04,"90th_percentile":4682.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":537.0,"10th_percentile":537.0,"90th_percentile":537.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":799.35,"10th_percentile":799.35,"90th_percentile":799.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":151.63,"10th_percentile":151.63,"90th_percentile":151.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":1676.59,"10th_percentile":1676.59,"90th_percentile":4149.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":430.57,"10th_percentile":430.57,"90th_percentile":430.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":1987.03,"10th_percentile":1987.03,"90th_percentile":1987.03,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":96.25,"10th_percentile":96.25,"90th_percentile":96.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":10791.93,"10th_percentile":10791.93,"90th_percentile":10791.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":76.85,"10th_percentile":76.85,"90th_percentile":76.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"15","median_amount":466.2,"10th_percentile":226.48,"90th_percentile":499.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"429","median_amount":605.25,"10th_percentile":240.31,"90th_percentile":1002.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"67","median_amount":564.5,"10th_percentile":137.56,"90th_percentile":1139.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":247.37,"10th_percentile":54.22,"90th_percentile":4941.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"41","median_amount":601.14,"10th_percentile":247.62,"90th_percentile":825.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"29","median_amount":323.7,"10th_percentile":157.67,"90th_percentile":717.6},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"79","median_amount":298.41,"10th_percentile":103.21,"90th_percentile":424.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"52","median_amount":307.15,"10th_percentile":103.21,"90th_percentile":468.04,"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 Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"27","median_amount":110.0,"10th_percentile":95.0,"90th_percentile":311.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"23","median_amount":740.18,"10th_percentile":436.49,"90th_percentile":3175.77,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":392.43,"10th_percentile":325.9,"90th_percentile":772.98,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":1432.78,"10th_percentile":4.31,"90th_percentile":1730.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"171","median_amount":459.0,"10th_percentile":255.0,"90th_percentile":600.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"1 through 10","median_amount":2158.2,"10th_percentile":2158.2,"90th_percentile":2158.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"90","median_amount":239.65,"10th_percentile":200.8,"90th_percentile":372.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"253","median_amount":190.1,"10th_percentile":57.35,"90th_percentile":4814.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":128.66,"10th_percentile":124.26,"90th_percentile":129.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":130.54,"10th_percentile":130.54,"90th_percentile":130.54,"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 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":2795.88,"10th_percentile":931.96,"90th_percentile":5324.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"208","median_amount":1295.82,"10th_percentile":515.57,"90th_percentile":8811.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"24","median_amount":994.16,"10th_percentile":449.95,"90th_percentile":1576.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":587.23,"10th_percentile":246.35,"90th_percentile":1042.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"16","median_amount":911.0,"10th_percentile":709.91,"90th_percentile":1608.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":716.46,"10th_percentile":430.59,"90th_percentile":1002.0},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"38","median_amount":1749.79,"10th_percentile":562.12,"90th_percentile":5655.13,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"15","median_amount":887.1,"10th_percentile":391.24,"90th_percentile":2137.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"22","median_amount":612.75,"10th_percentile":155.5,"90th_percentile":837.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":891.02,"10th_percentile":891.02,"90th_percentile":891.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":2691.52,"10th_percentile":2445.41,"90th_percentile":3389.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"26","median_amount":573.17,"10th_percentile":203.3,"90th_percentile":1022.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":120.0,"10th_percentile":120.0,"90th_percentile":120.0},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":571.68,"10th_percentile":571.68,"90th_percentile":571.68},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"72","median_amount":1109.24,"10th_percentile":371.0,"90th_percentile":5088.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"48","median_amount":1214.28,"10th_percentile":313.42,"90th_percentile":1674.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"234","median_amount":606.15,"10th_percentile":189.36,"90th_percentile":1640.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":960.35,"10th_percentile":847.76,"90th_percentile":1134.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":203.16,"10th_percentile":203.16,"90th_percentile":203.16,"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."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":649.11,"10th_percentile":649.11,"90th_percentile":649.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":31043.96,"10th_percentile":31043.96,"90th_percentile":61167.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16514.43,"10th_percentile":16514.43,"90th_percentile":16514.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":18897.2,"10th_percentile":18897.2,"90th_percentile":18897.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"15","median_amount":2021.49,"10th_percentile":1728.94,"90th_percentile":4988.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"20","median_amount":12897.93,"10th_percentile":10264.74,"90th_percentile":22413.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"22","median_amount":1093.5,"10th_percentile":955.0,"90th_percentile":1114.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"416","median_amount":560.34,"10th_percentile":411.0,"90th_percentile":603.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"56","median_amount":502.0,"10th_percentile":164.98,"90th_percentile":603.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":137.81,"10th_percentile":120.05,"90th_percentile":153.12,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"24","median_amount":400.72,"10th_percentile":263.45,"90th_percentile":411.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":603.0,"10th_percentile":603.0,"90th_percentile":1620.0},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"48","median_amount":228.87,"10th_percentile":228.87,"90th_percentile":240.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"23","median_amount":228.87,"10th_percentile":228.87,"90th_percentile":240.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"14","median_amount":1354.86,"10th_percentile":1053.0,"90th_percentile":1404.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"26","median_amount":987.0,"10th_percentile":690.9,"90th_percentile":1006.5,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":918.0,"10th_percentile":918.0,"90th_percentile":918.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":138.08,"10th_percentile":133.88,"90th_percentile":153.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":203.5,"10th_percentile":203.5,"90th_percentile":203.5},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"185","median_amount":1133.93,"10th_percentile":292.26,"90th_percentile":1169.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"43","median_amount":178.01,"10th_percentile":178.01,"90th_percentile":186.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":148.03,"10th_percentile":148.03,"90th_percentile":148.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"119","median_amount":146.03,"10th_percentile":120.02,"90th_percentile":150.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":150.86,"10th_percentile":150.86,"90th_percentile":150.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":2340.34,"10th_percentile":874.8,"90th_percentile":2928.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"140","median_amount":1722.84,"10th_percentile":732.0,"90th_percentile":2389.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"11","median_amount":1335.09,"10th_percentile":790.84,"90th_percentile":1907.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"42","median_amount":298.66,"10th_percentile":268.49,"90th_percentile":456.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1282.93,"10th_percentile":672.0,"90th_percentile":1580.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2067.88,"10th_percentile":2067.88,"90th_percentile":2067.88},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"29","median_amount":955.66,"10th_percentile":459.88,"90th_percentile":1108.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"17","median_amount":1037.76,"10th_percentile":459.88,"90th_percentile":1228.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"13","median_amount":487.5,"10th_percentile":293.0,"90th_percentile":817.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"14","median_amount":1717.12,"10th_percentile":387.99,"90th_percentile":2508.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":510.44,"10th_percentile":510.44,"90th_percentile":510.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":299.25,"10th_percentile":296.45,"90th_percentile":558.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":490.76,"10th_percentile":490.76,"90th_percentile":490.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"42","median_amount":866.7,"10th_percentile":589.6,"90th_percentile":1166.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"26","median_amount":833.38,"10th_percentile":371.64,"90th_percentile":974.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"158","median_amount":295.61,"10th_percentile":262.36,"90th_percentile":441.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":300.26,"10th_percentile":287.47,"90th_percentile":300.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":300.26,"10th_percentile":300.26,"90th_percentile":300.26,"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."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":2400.0,"10th_percentile":2400.0,"90th_percentile":2400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":241.18,"10th_percentile":241.18,"90th_percentile":241.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":2639.0,"10th_percentile":2639.0,"90th_percentile":2639.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":364.0,"10th_percentile":264.0,"90th_percentile":412.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":3373.23,"10th_percentile":3373.23,"90th_percentile":3373.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"58","median_amount":2484.5,"10th_percentile":1736.0,"90th_percentile":3216.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2598.42,"10th_percentile":1937.6,"90th_percentile":2768.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":941.52,"10th_percentile":784.72,"90th_percentile":979.72,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2000.0,"10th_percentile":1764.0,"90th_percentile":2272.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2894.4,"10th_percentile":2894.4,"90th_percentile":2894.4},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"18","median_amount":1531.89,"10th_percentile":1531.89,"90th_percentile":1561.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"12","median_amount":1531.89,"10th_percentile":1531.89,"90th_percentile":1561.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1404.0,"10th_percentile":1404.0,"90th_percentile":1404.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":2295.13,"10th_percentile":2295.13,"90th_percentile":2295.13,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":2445.0,"10th_percentile":2445.0,"90th_percentile":2445.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":977.74,"10th_percentile":782.19,"90th_percentile":982.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"33","median_amount":2525.59,"10th_percentile":1847.3,"90th_percentile":2712.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"40","median_amount":1191.47,"10th_percentile":1191.47,"90th_percentile":1214.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"87","median_amount":971.62,"10th_percentile":890.18,"90th_percentile":976.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":981.01,"10th_percentile":981.01,"90th_percentile":981.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":854.15,"10th_percentile":854.15,"90th_percentile":854.15,"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."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":188.11,"10th_percentile":188.11,"90th_percentile":188.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":33.6,"10th_percentile":33.6,"90th_percentile":89.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":37.58,"10th_percentile":37.58,"90th_percentile":195.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":71.09,"10th_percentile":71.09,"90th_percentile":71.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":29.23,"10th_percentile":29.23,"90th_percentile":187.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"27","median_amount":685.64,"10th_percentile":282.83,"90th_percentile":2015.78,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":150.06,"10th_percentile":150.06,"90th_percentile":320.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":2123.0,"10th_percentile":350.46,"90th_percentile":3445.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":155.81,"10th_percentile":155.81,"90th_percentile":155.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"31","median_amount":201.16,"10th_percentile":35.88,"90th_percentile":357.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"11","median_amount":259.89,"10th_percentile":79.5,"90th_percentile":577.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"202","median_amount":223.83,"10th_percentile":163.48,"90th_percentile":459.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"18","median_amount":203.26,"10th_percentile":150.08,"90th_percentile":675.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":57.28,"10th_percentile":52.33,"90th_percentile":296.56,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"18","median_amount":187.6,"10th_percentile":145.78,"90th_percentile":230.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"14","median_amount":301.5,"10th_percentile":170.8,"90th_percentile":505.0},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"37","median_amount":117.41,"10th_percentile":89.62,"90th_percentile":328.12,"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":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"23","median_amount":91.13,"10th_percentile":89.62,"90th_percentile":288.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"20","median_amount":166.5,"10th_percentile":101.25,"90th_percentile":1594.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22.28,"10th_percentile":22.28,"90th_percentile":22.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"12","median_amount":220.43,"10th_percentile":204.72,"90th_percentile":460.32,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":128.76,"10th_percentile":128.76,"90th_percentile":128.76,"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":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":441.16,"10th_percentile":441.16,"90th_percentile":441.16,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":57.78,"10th_percentile":57.78,"90th_percentile":57.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":57.08,"10th_percentile":45.67,"90th_percentile":164.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":123.04,"10th_percentile":123.04,"90th_percentile":123.04},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"86","median_amount":226.0,"10th_percentile":193.7,"90th_percentile":432.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"53","median_amount":73.84,"10th_percentile":69.71,"90th_percentile":220.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":52.32,"10th_percentile":52.32,"90th_percentile":52.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"292","median_amount":54.97,"10th_percentile":32.47,"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":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":57.28,"10th_percentile":57.28,"90th_percentile":429.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12.28,"10th_percentile":12.28,"90th_percentile":12.28,"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."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"11","median_amount":639.25,"10th_percentile":367.78,"90th_percentile":2013.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"109","median_amount":335.5,"10th_percentile":93.13,"90th_percentile":436.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"14","median_amount":360.56,"10th_percentile":277.2,"90th_percentile":400.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":123.63,"10th_percentile":101.49,"90th_percentile":370.89,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":356.88,"10th_percentile":308.0,"90th_percentile":367.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":536.17,"10th_percentile":400.77,"90th_percentile":1846.98},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":197.8,"10th_percentile":187.15,"90th_percentile":687.29,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":409.43,"10th_percentile":197.8,"90th_percentile":930.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":271.0,"10th_percentile":193.9,"90th_percentile":277.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":409.98,"10th_percentile":409.98,"90th_percentile":434.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":2056.53,"10th_percentile":2056.53,"90th_percentile":2056.53,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":113.76,"10th_percentile":110.04,"90th_percentile":247.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":388.51,"10th_percentile":388.51,"90th_percentile":388.51},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"58","median_amount":180.9,"10th_percentile":16.49,"90th_percentile":461.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"15","median_amount":153.85,"10th_percentile":145.56,"90th_percentile":253.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"46","median_amount":123.11,"10th_percentile":99.25,"90th_percentile":546.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":124.26,"10th_percentile":124.26,"90th_percentile":124.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":265.5,"10th_percentile":265.5,"90th_percentile":265.5,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"78","median_amount":1113.0,"10th_percentile":159.0,"90th_percentile":1908.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":1050.13,"10th_percentile":334.71,"90th_percentile":1495.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"16","median_amount":702.0,"10th_percentile":230.0,"90th_percentile":819.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":447.0,"10th_percentile":447.0,"90th_percentile":447.0},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":193.19,"10th_percentile":193.19,"90th_percentile":386.38,"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":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1161.66,"10th_percentile":1161.66,"90th_percentile":1161.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":702.0,"10th_percentile":117.0,"90th_percentile":1170.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":2213.8,"10th_percentile":1992.42,"90th_percentile":2656.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1216.98,"10th_percentile":691.55,"90th_percentile":2124.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":1728.44,"10th_percentile":1728.44,"90th_percentile":1728.44,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":968.0,"10th_percentile":444.8,"90th_percentile":1331.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"22","median_amount":1258.16,"10th_percentile":745.0,"90th_percentile":1860.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"83","median_amount":603.75,"10th_percentile":120.75,"90th_percentile":1328.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"42","median_amount":849.87,"10th_percentile":227.26,"90th_percentile":1456.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":2010.94,"10th_percentile":2010.94,"90th_percentile":2010.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":1575.18,"10th_percentile":1314.59,"90th_percentile":4940.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":604.03,"10th_percentile":604.03,"90th_percentile":604.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1402.31,"10th_percentile":1402.31,"90th_percentile":1402.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":2277.0,"10th_percentile":2277.0,"90th_percentile":2277.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":1644.99,"10th_percentile":1644.99,"90th_percentile":1644.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":627.38,"10th_percentile":546.86,"90th_percentile":651.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"26","median_amount":619.52,"10th_percentile":398.36,"90th_percentile":784.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":1598.7,"10th_percentile":1598.7,"90th_percentile":1598.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"28","median_amount":870.65,"10th_percentile":369.6,"90th_percentile":1202.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":522.4,"10th_percentile":522.4,"90th_percentile":522.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":195.08,"10th_percentile":195.08,"90th_percentile":319.56,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":836.0,"10th_percentile":836.0,"90th_percentile":836.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"21","median_amount":604.19,"10th_percentile":506.33,"90th_percentile":963.13,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"17","median_amount":683.29,"10th_percentile":417.49,"90th_percentile":940.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":1088.15,"10th_percentile":646.85,"90th_percentile":1244.63,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":268.6,"10th_percentile":268.6,"90th_percentile":268.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1430.32,"10th_percentile":1430.32,"90th_percentile":1430.32},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":820.48,"10th_percentile":255.0,"90th_percentile":996.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"14","median_amount":548.11,"10th_percentile":503.15,"90th_percentile":925.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"16","median_amount":221.01,"10th_percentile":179.12,"90th_percentile":364.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Health and Behavior Services","code_information":[{"code":"5822","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":4767.66,"10th_percentile":2063.12,"90th_percentile":7510.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"96","median_amount":3202.5,"10th_percentile":1062.86,"90th_percentile":5960.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":6984.0,"10th_percentile":6984.0,"90th_percentile":6984.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":1668.28,"10th_percentile":1249.18,"90th_percentile":1998.66,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"14","median_amount":2385.6,"10th_percentile":435.3,"90th_percentile":3880.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1932.48,"10th_percentile":1932.48,"90th_percentile":1932.48},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1440.0,"10th_percentile":240.0,"90th_percentile":3360.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":235.22,"10th_percentile":235.22,"90th_percentile":235.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":2303.52,"10th_percentile":1622.64,"90th_percentile":3788.88,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":273.0,"10th_percentile":109.2,"90th_percentile":305.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"12","median_amount":1750.15,"10th_percentile":620.43,"90th_percentile":2274.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"1 through 10","median_amount":1654.48,"10th_percentile":1654.48,"90th_percentile":1654.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":171.55,"10th_percentile":136.97,"90th_percentile":967.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":1107.24,"10th_percentile":309.0,"90th_percentile":2970.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2190.48,"10th_percentile":2190.48,"90th_percentile":2190.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":229.95,"10th_percentile":229.95,"90th_percentile":306.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"12","median_amount":59.5,"10th_percentile":47.6,"90th_percentile":126.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":123.31,"10th_percentile":123.31,"90th_percentile":123.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":183.23,"10th_percentile":183.23,"90th_percentile":183.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":137.54,"10th_percentile":137.54,"90th_percentile":137.54},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"183","median_amount":144.72,"10th_percentile":97.54,"90th_percentile":177.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"176","median_amount":124.71,"10th_percentile":95.63,"90th_percentile":156.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":233.6,"10th_percentile":233.6,"90th_percentile":233.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"157","median_amount":127.2,"10th_percentile":97.54,"90th_percentile":177.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, clindamycin phosp 300mg","code_information":[{"code":"9291","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":4918.93,"10th_percentile":4918.93,"90th_percentile":4918.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":1266.99,"10th_percentile":1266.99,"90th_percentile":1266.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3635.21,"10th_percentile":3635.21,"90th_percentile":3706.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukoreduced irradiated","code_information":[{"code":"9522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":928.03,"10th_percentile":928.03,"90th_percentile":928.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Plate pheres leukoredu irrad","code_information":[{"code":"9530","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":2105.59,"10th_percentile":2105.59,"90th_percentile":2105.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":332.15,"10th_percentile":138.67,"90th_percentile":624.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":3295.0,"10th_percentile":3295.0,"90th_percentile":3295.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2116.73,"10th_percentile":2116.73,"90th_percentile":2116.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"105","median_amount":137.46,"10th_percentile":93.88,"90th_percentile":158.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1723","median_amount":150.64,"10th_percentile":91.76,"90th_percentile":213.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"234","median_amount":130.8,"10th_percentile":85.16,"90th_percentile":210.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"89","median_amount":123.6,"10th_percentile":49.45,"90th_percentile":247.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"92","median_amount":130.8,"10th_percentile":100.8,"90th_percentile":218.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"154","median_amount":155.2,"10th_percentile":93.2,"90th_percentile":218.0},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"748","median_amount":193.68,"10th_percentile":170.0,"90th_percentile":194.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"450","median_amount":190.2,"10th_percentile":166.67,"90th_percentile":193.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"19","median_amount":35.0,"10th_percentile":5.0,"90th_percentile":190.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"116","median_amount":125.61,"10th_percentile":102.12,"90th_percentile":143.44,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":383.58,"10th_percentile":383.58,"90th_percentile":383.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"14","median_amount":118.73,"10th_percentile":68.73,"90th_percentile":133.42,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":60.14,"10th_percentile":60.14,"90th_percentile":60.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"33","median_amount":60.14,"10th_percentile":44.87,"90th_percentile":118.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"20","median_amount":185.0,"10th_percentile":100.0,"90th_percentile":272.12},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"786","median_amount":185.0,"10th_percentile":136.0,"90th_percentile":218.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"1 through 10","median_amount":158.0,"10th_percentile":158.0,"90th_percentile":158.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"694","median_amount":150.64,"10th_percentile":150.64,"90th_percentile":153.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":124.58,"10th_percentile":123.58,"90th_percentile":247.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"551","median_amount":123.58,"10th_percentile":107.6,"90th_percentile":247.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"116","median_amount":124.26,"10th_percentile":113.68,"90th_percentile":124.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":124.26,"10th_percentile":124.26,"90th_percentile":124.26,"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."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"291","median_amount":250.78,"10th_percentile":40.0,"90th_percentile":570.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"4592","median_amount":150.16,"10th_percentile":31.71,"90th_percentile":362.85,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"587","median_amount":161.1,"10th_percentile":26.86,"90th_percentile":410.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"940","median_amount":33.49,"10th_percentile":9.66,"90th_percentile":100.87,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"301","median_amount":128.96,"10th_percentile":29.11,"90th_percentile":356.82,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"305","median_amount":186.71,"10th_percentile":52.72,"90th_percentile":463.2},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1549","median_amount":220.46,"10th_percentile":19.53,"90th_percentile":334.33,"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":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"974","median_amount":216.98,"10th_percentile":24.39,"90th_percentile":330.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"471","median_amount":45.0,"10th_percentile":15.0,"90th_percentile":105.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":33.66,"10th_percentile":10.35,"90th_percentile":102.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":173.96,"10th_percentile":173.96,"90th_percentile":173.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"481","median_amount":263.2,"10th_percentile":80.93,"90th_percentile":625.09,"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":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":77.17,"10th_percentile":77.17,"90th_percentile":77.17,"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":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":69.27,"10th_percentile":65.05,"90th_percentile":99.39,"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":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":56.48,"10th_percentile":56.48,"90th_percentile":119.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"70","median_amount":250.21,"10th_percentile":64.79,"90th_percentile":529.79,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":31.62,"10th_percentile":31.62,"90th_percentile":49.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"451","median_amount":36.1,"10th_percentile":9.68,"90th_percentile":102.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":40.0,"10th_percentile":22.73,"90th_percentile":543.2},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"47","median_amount":158.09,"10th_percentile":22.8,"90th_percentile":489.03},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"2486","median_amount":63.16,"10th_percentile":12.84,"90th_percentile":422.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"29","median_amount":54.66,"10th_percentile":13.89,"90th_percentile":236.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1412","median_amount":171.47,"10th_percentile":11.2,"90th_percentile":263.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"29","median_amount":51.57,"10th_percentile":11.13,"90th_percentile":130.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"3085","median_amount":39.44,"10th_percentile":10.51,"90th_percentile":124.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"82","median_amount":124.26,"10th_percentile":49.72,"90th_percentile":194.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"50","median_amount":39.0,"10th_percentile":9.71,"90th_percentile":119.41,"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."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"55","median_amount":634.53,"10th_percentile":169.13,"90th_percentile":1596.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1153","median_amount":597.19,"10th_percentile":226.44,"90th_percentile":1688.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"137","median_amount":564.93,"10th_percentile":208.09,"90th_percentile":1439.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"163","median_amount":188.11,"10th_percentile":74.95,"90th_percentile":545.1,"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":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"64","median_amount":711.65,"10th_percentile":264.88,"90th_percentile":1494.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"42","median_amount":353.19,"10th_percentile":155.0,"90th_percentile":841.8},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"177","median_amount":357.06,"10th_percentile":119.02,"90th_percentile":714.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"147","median_amount":357.06,"10th_percentile":119.07,"90th_percentile":817.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"57","median_amount":340.2,"10th_percentile":130.5,"90th_percentile":792.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"103","median_amount":727.75,"10th_percentile":311.23,"90th_percentile":1885.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":838.44,"10th_percentile":256.46,"90th_percentile":1817.82,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":144.12,"10th_percentile":144.12,"90th_percentile":525.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"134","median_amount":301.49,"10th_percentile":94.69,"90th_percentile":682.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":304.88,"10th_percentile":209.38,"90th_percentile":651.7},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"452","median_amount":637.5,"10th_percentile":213.84,"90th_percentile":1554.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"226","median_amount":277.71,"10th_percentile":92.61,"90th_percentile":762.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":471.88,"10th_percentile":276.38,"90th_percentile":684.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1001","median_amount":230.95,"10th_percentile":83.54,"90th_percentile":555.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":282.0,"10th_percentile":72.77,"90th_percentile":527.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":269.13,"10th_percentile":79.73,"90th_percentile":277.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"53","median_amount":326.59,"10th_percentile":225.99,"90th_percentile":326.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"911","median_amount":397.3,"10th_percentile":391.89,"90th_percentile":397.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"128","median_amount":329.81,"10th_percentile":319.43,"90th_percentile":397.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"90","median_amount":96.5,"10th_percentile":96.5,"90th_percentile":99.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"92","median_amount":315.94,"10th_percentile":310.96,"90th_percentile":315.94,"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":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"66","median_amount":391.89,"10th_percentile":391.89,"90th_percentile":397.3},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"55","median_amount":273.98,"10th_percentile":273.98,"90th_percentile":276.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"20","median_amount":276.34,"10th_percentile":273.98,"90th_percentile":276.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"51","median_amount":252.0,"10th_percentile":246.0,"90th_percentile":252.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":131.22,"10th_percentile":131.22,"90th_percentile":131.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"67","median_amount":294.78,"10th_percentile":275.11,"90th_percentile":294.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":169.71,"10th_percentile":164.92,"90th_percentile":169.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":274.18,"10th_percentile":263.16,"90th_percentile":274.18,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":96.68,"10th_percentile":96.68,"90th_percentile":96.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"53","median_amount":96.68,"10th_percentile":96.68,"90th_percentile":99.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":282.78,"10th_percentile":279.29,"90th_percentile":328.0},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"421","median_amount":274.77,"10th_percentile":274.77,"90th_percentile":274.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"1 through 10","median_amount":274.77,"10th_percentile":274.77,"90th_percentile":274.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"41","median_amount":214.93,"10th_percentile":213.1,"90th_percentile":214.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"1 through 10","median_amount":96.49,"10th_percentile":96.49,"90th_percentile":96.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"582","median_amount":96.49,"10th_percentile":96.49,"90th_percentile":99.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":97.01,"10th_percentile":97.01,"90th_percentile":97.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":97.01,"10th_percentile":97.01,"90th_percentile":97.01,"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."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":279.94,"10th_percentile":279.94,"90th_percentile":279.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"32","median_amount":384.0,"10th_percentile":345.6,"90th_percentile":798.33,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":332.67,"10th_percentile":296.0,"90th_percentile":486.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":91.04,"10th_percentile":91.04,"90th_percentile":97.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":472.68,"10th_percentile":472.68,"90th_percentile":472.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":384.0,"10th_percentile":384.0,"90th_percentile":465.57},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":243.09,"10th_percentile":192.06,"90th_percentile":243.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":190.24,"10th_percentile":190.24,"90th_percentile":190.24,"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":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":252.0,"10th_percentile":252.0,"90th_percentile":286.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"1 through 10","median_amount":247.62,"10th_percentile":247.62,"90th_percentile":247.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":266.75,"10th_percentile":266.75,"90th_percentile":266.75},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"19","median_amount":384.0,"10th_percentile":376.32,"90th_percentile":620.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":149.38,"10th_percentile":147.97,"90th_percentile":149.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"23","median_amount":86.34,"10th_percentile":83.34,"90th_percentile":106.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":73.15,"10th_percentile":73.15,"90th_percentile":73.15,"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."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":235.68,"10th_percentile":235.68,"90th_percentile":235.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":4.81,"10th_percentile":4.81,"90th_percentile":4.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":2026.5,"10th_percentile":2026.5,"90th_percentile":2026.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Influenza Vaccines & Pneumococcal Pneumonia Vaccines","code_information":[{"code":"N903","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"1 through 10","median_amount":68.74,"10th_percentile":68.74,"90th_percentile":68.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 72.9] [Observation (%BC): 72.9] [Emergency Department (%BC): 72.9] [Occupational Therapy (%BC): 72.9] [Physical Therapy (%BC): 72.9] [Respiratory Services/Therapy  (%BC): 72.9] [Speech Therapy (%BC): 72.9] [All Other OP (%BC): 72.9]","count":"1 through 10","median_amount":82.66,"10th_percentile":82.66,"90th_percentile":82.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 5095] [OP Surg. Minor ($): 3465] [Arthroscopy ($): 10444] [Cardiac Cath ($): 10512] [Endoscopy ($): 1774] [Insertion of Permanent Pacemaker ($): 12545] [Joint Replacement-Full/Partial ($): 11193] [Laminectomy/Diskectomy ($): 12796] [Laparoscopy ($): 8846] [Lithotripsy ($): 10236] [PTCA ($): 19788] [Spinal Surgery ($): 18937] [Observation ($): 4423] [Emergency Department ($): 1002] [Cardiac Rehabilitation Therapy ($): 159] [Cardiology ($): 1119] [Echocardiology ($): 1039] [Other Cardiac Testing ($): 2985] [Peripheral Vascular Lab ($): 666] [EEG ($): 1119] [Sleep Studies ($): 3216] [Chemotherapy (%BC): 61] [Radiation Therapy  (%BC): 61] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 61] [Physical Therapy (%BC): 61] [Respiratory Services/Therapy  (%BC): 61] [Speech Therapy (%BC): 61] [Mental Health-Partial Hospitalization ($): 1157] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 245] [Pulmonary Function ($): 586] [All Other OP (%BC): 61]","count":"1 through 10","median_amount":38.74,"10th_percentile":38.74,"90th_percentile":40.33,"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":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 4130] [OP Surg. Minor ($): 3098] [Arthroscopy ($): 8806] [Cardiac Cath ($): 8347] [Endoscopy ($): 1550] [Insertion of Permanent Pacemaker ($): 10434] [Joint Replacement-Full/Partial ($): 9780] [Laminectomy/Diskectomy ($): 10732] [Laparoscopy ($): 6500] [Lithotripsy ($): 8758] [PTCA ($): 17289] [Spinal Surgery ($): 16248] [Observation ($): 3344] [Emergency Department ($): 934] [Cardiac Rehabilitation Therapy ($): 141] [Cardiology ($): 1056] [Echocardiology ($): 909] [Other Cardiac Testing ($): 2370] [Peripheral Vascular Lab ($): 624] [EEG ($): 1056] [Sleep Studies ($): 2768] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 901] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 209] [Pulmonary Function ($): 466] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Major ($): 3454] [OP Surg. Minor ($): 2504] [Arthroscopy ($): 7123] [Cardiac Cath ($): 6752] [Endoscopy ($): 1254] [Insertion of Permanent Pacemaker ($): 8440] [Joint Replacement-Full/Partial ($): 7440] [Laminectomy/Diskectomy ($): 8682] [Laparoscopy ($): 5546] [Lithotripsy ($): 7084] [PTCA ($): 13986] [Spinal Surgery ($): 13143] [Observation ($): 2744] [Emergency Department ($): 825] [Cardiac Rehabilitation Therapy ($): 117] [Cardiology ($): 1016] [Echocardiology ($): 877] [Other Cardiac Testing ($): 1917] [Peripheral Vascular Lab ($): 597] [EEG ($): 1016] [Sleep Studies ($): 2272] [Chemotherapy (%BC): 56] [Radiation Therapy  (%BC): 56] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health-Partial Hospitalization ($): 740] [Other Outpatient Implant (%BC): 58] [IV Therapy ($): 194] [Pulmonary Function ($): 377] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":38.02,"10th_percentile":38.02,"90th_percentile":38.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery-Single ($): 2277] [Ablation ($): 5446] [Bariatric Surgery ($): 7496] [Cardiac Cath ($): 7666] [Endoscopy ($): 1647] [Lap Chole ($): 5257] [Laparoscopy ($): 4383] [Lithotripsy ($): 5110] [Spinal Surgery ($): 7302] [Observation ($): 4556] [Emergency Department ($): 837] [Urgent Care ($): 215] [Cardiac Rehabilitation Therapy ($): 117] [Cardiac Stress Test ($): 775] [Cardiology ($): 578] [Echocardiology ($): 284] [EKG/ECG ($): 123] [Holter Monitor/Telemetry ($): 277] [Peripheral Vascular Lab ($): 716] [EEG ($): 289] [EMG ($): 293] [Neuropsychological Testing and Biofeedback ($): 370] [Sleep Studies-Attended ($): 1404] [Sleep Studies-Unattended ($): 1404] [Brachytherapy ($): 14491] [Chemotherapy ($): 524] [Nuclear Medicine ($): 708] [Oncology ($): 133] [Radiation Therapy ($): 492] [CT Scan OP ($): 740] [MRI OP ($): 1048] [Imaging Services ($): 112] [Mammography-Diagnostic ($): 126] [Mammography-Screening ($): 126] [Positron Emission Tomography ($): 2647] [Radiology ($): 116] [Ultrasound Imaging ($): 171] [Laboratory ($): 15] [Pathology ($): 15] [Hemodialysis ($): 453] [Peritoneal Dialysis, CAPD, and CCPD ($): 453] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Resp. Services/Therapy ($): 110] [Speech Therapy ($): 132] [Mental Health-Intensive ($): 255] [Mental Health-Partial Hospitalization ($): 354] [OP ECT Mental Health ($): 556] [OP High Cost Drugs ($): 0 Charge Threshold 1200 (%BC): 30] [Other Outpatient Implant ($): 0 Charge Threshold 2100 (%BC): 58] [Hyperbarics ($): 227] [IV Therapy ($): 311] [Pulmonary Function ($): 650] [Pulmonary Rehabilitation ($): 86] [Trauma ($): 3466] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3766] [Arthroscopy ($): 7852] [Cardiac Cath ($): 10679] [Insertion of Permanent Pacemaker ($): 11517] [Lap Chole ($): 8376] [Laparoscopy ($): 8794] [Lithotripsy ($): 10364] [Spinal Surgery ($): 20939] [Observation (%BC): 67.1] [Emergency Department (%BC): 67.1] [Urgent Care (%BC): 67.1] [Chemotherapy (%BC): 67.1] [Nuclear Medicine (%BC): 67.1] [Radiation Therapy  (%BC): 67.1] [CT OP Scan (%BC): 57.3] [MRI OP (%BC): 57.3] [Positron Emission Tomography (%BC): 57.3] [Radiology (%BC): 67.1] [Laboratory (%BC): 67.1] [Hemodialysis (%BC): 67.1] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 67.1] [Occupational Therapy (%BC): 67.1] [Physical Therapy (%BC): 67.1] [Respiratory Services/Therapy  (%BC): 67.1] [Speech Therapy (%BC): 67.1] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy (%): 14] [Other Outpatient Implant (%BC): 60] [All Other OP (%BC): 67.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Mental Health-Partial Hospitalization ($): 225] [OP ECT Mental Health ($): 475] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 7721] [Arthroscopy ($): 14255] [Cardiac Cath ($): 15840] [Insertion of Permanent Pacemaker ($): 14255] [Joint Replacement-Full/Partial ($): 11027] [Lap Chole ($): 13514] [Laparoscopy ($): 13642] [Lithotripsy ($): 16045] [Spinal Surgery ($): 17836] [Observation ($): 7766] [Emergency Department ($): 2096] [OP High Cost Drugs (%BC): 65] [Other Outpatient Implant (%BC): 65] [All Other OP (%BC): 61.2 Charge Threshold 101066 (%BC): 61.2]","count":"1 through 10","median_amount":146.88,"10th_percentile":146.88,"90th_percentile":146.88,"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":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3233] [Arthroscopy ($): 7888] [Cardiac Cath ($): 10988] [Insertion of Permanent Pacemaker ($): 12914] [Joint Replacement-Full/Partial ($): 9856] [Lap Chole ($): 6629] [Lithotripsy ($): 8903] [PTCA w/ Drug Eluting Stent ($): 14326] [Spinal Surgery ($): 10305] [Observation ($): 3083] [ED Level 1--99281 ($): 1107] [ED Level 2--99282 ($): 1107] [ED Level 3--99283 ($): 1107] [ED Level 4--99284 ($): 1107] [ED Level 5--99285 ($): 1107] [Critical Care-99291 ($): 1107] [Urgent Care ($): 472] [Clinic Visit ($): 184] [Cardiac Rehabilitation Therapy ($): 155] [Cardiac Stress Test ($): 687] [Cardiology ($): 638] [Echocardiology ($): 239] [EKG/ECG ($): 226] [Holter Monitor/Telemetry ($): 207] [Peripheral Vascular Lab ($): 487] [EEG ($): 737] [EMG ($): 329] [Neuropsychological Testing and Biofeedback ($): 631] [Sleep Studies-Attended ($): 2712] [Sleep Studies-Unattended ($): 1169] [Chemotherapy ($): 661] [Oncology ($): 693] [Radiation Therapy ($): 590] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1131] [Peritoneal Dialysis, CAPD, and CCPD ($): 1131] [Occupational Therapy ($): 222] [Physical Therapy ($): 222] [Resp. Services/Therapy ($): 198] [Speech Therapy ($): 222] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 53] [Ambulance--Air ($): 472] [Ambulance--Land ($): 472] [Hyperbarics ($): 607] [IV Therapy ($): 381] [Pulmonary Function ($): 321] [Pulmonary Rehabilitation ($): 325]","count":"1 through 10","median_amount":102.99,"10th_percentile":101.96,"90th_percentile":109.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1098] [Urgent Care ($): 318] [Mental Health-Partial Hospitalization ($): 520] [OP ECT Mental Health ($): 958]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Observation ($): 1035] [Urgent Care ($): 300] [Mental Health-Partial Hospitalization ($): 490] [OP ECT Mental Health ($): 902.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":106.41,"10th_percentile":106.41,"90th_percentile":106.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":84204.66,"maximum":152406.63,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":152406.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85940.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84670.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118538.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84670.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88903.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143939.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86109.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84670.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84670.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":84670.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84204.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":84670.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84670.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Pacemaker Revision Or Device Replacement With Mcc","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":43155.77,"maximum":78109.99,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78109.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44045.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43394.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60752.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43394.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45564.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73770.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44132.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43394.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43394.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":43394.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43155.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":43394.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43394.44,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19129.46,"maximum":34623.45,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34623.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19523.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19235.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26929.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19235.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20197.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32699.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19562.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19235.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19235.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19235.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19129.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19235.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19235.25,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":26564.03,"maximum":48079.69,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48079.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27111.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26710.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37395.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26710.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28046.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45408.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27165.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26710.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26710.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26710.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26564.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":26710.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26710.94,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19071.67,"maximum":34518.85,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34518.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19464.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19177.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26848.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19177.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20136.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32601.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19503.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19177.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19177.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19177.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19071.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"fee schedule","standard_charge_dollar":19177.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19177.14,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Circulatory System O.R. Procedures With Mcc","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","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":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 94650 | Total % of Charge: 63.8] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2426] [Surgical-Per Diem: 2426] [ICU-Per Diem: 3032] [CCU-Per Diem: 3032] [Step Down-Per Diem: 3032] [C-Section-Per Diem: 2378] [Normal Vaginal Delivery-Per Diem: 2378] [Nursery  Level 1- Boarder-Per Diem: 705] [Nursery  Level 2-Per Diem: 705] [Nursery  Level 3-Per Diem: 705] [Nursery  Level 4-NICU-Per Diem: 1432] [Alcohol/ Chemical Dependency-Per Diem: 880] [Psych-Per Diem: 880]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 135016 | Total % of Charge: 6437] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 9208] [Normal Vaginal Delivery-Case Rate: 6438] [Nursery  Level 1- Boarder-Per Diem: 1023] [Nursery  Level 2-Per Diem: 2192] [Nursery  Level 3-Per Diem: 2192] [Nursery  Level 4-NICU-Per Diem: 2192] [Alcohol/ Chemical Dependency-Per Diem: 1706] [Psych-Per Diem: 1703] [Rehab-Per Diem: 1803] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 146059 | Total % of Charge: 5624] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8357] [Normal Vaginal Delivery-Case Rate: 5249] [Nursery  Level 1- Boarder-Per Diem: 826] [Nursery  Level 2-Per Diem: 1771] [Nursery  Level 3-Per Diem: 1771] [Nursery  Level 4-NICU-Per Diem: 1771] [Alcohol/ Chemical Dependency-Per Diem: 1363] [Psych-Per Diem: 1396] [Rehab-Per Diem: 1435] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 136085 | Total % of Charge: 5028] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6748] [Normal Vaginal Delivery-Case Rate: 4358] [Nursery  Level 1- Boarder-Per Diem: 687] [Nursery  Level 2-Per Diem: 1469] [Nursery  Level 3-Per Diem: 1469] [Nursery  Level 4-NICU-Per Diem: 1469] [Alcohol/ Chemical Dependency-Per Diem: 1147] [Psych-Per Diem: 1176] [Rehab-Per Diem: 1209] [IP Prosthetics/Implants/Devices (%BC): 54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Traditional","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Centene Home State Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 335776 | Total % of Charge: 4355] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7631 Days: 4 Additional Days: 1319] [Normal vag. Del. 2 day stay-Case Rate: 4613 Days: 2 Additional Days: 1319] [Normal Newborn-Per Diem: 680] [Lower Level Neonate-Per Diem: 1590] [Higher Level Neonate-Per Diem: 2215] [Severe Level Neonate-per diem: 3421] [Alcohol/ Chemical Dependency-Per Diem: 1340] [Psych-Per Diem: 1340] [Rehab-Per Diem: 2055] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2100 (%BC): 58] [Trauma-Case Rate: 3765]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 163269 | Total % of Charge: 57.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8331 Days: 4 Additional Days: 1345] [Normal vag. Del. 2 day stay-Case Rate: 6248 Days: 2 Additional Days: 1345] [Nursery  Level 1- Boarder-Per Diem: 1345] [Nursery  Level 2-Per Diem: 1345] [Nursery  Level 3-Per Diem: 1345] [Nursery  Level 4-NICU-Per Diem: 1345] [IP Prosthetics/Implants/Devices (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 500] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Corizon","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 101066 | Total % of Charge: 61.2] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 8363 Days: 4 Additional Days: 1411] [Normal vag. Del. 2 day stay-Case Rate: 6480 Days: 2 Additional Days: 1411] [Normal Newborn-Per Diem: 1255] [IP High Cost Drugs (%BC): 65] [IP Prosthetics/Implants/Devices (%BC): 65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1025] [Psych-Per Diem: 1025] [Rehab-Per Diem: 1090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MO Select","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Provider Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2805] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8996] [Normal Vaginal Delivery-Case Rate: 6758] [Normal Newborn-Per Diem: 1530] [Lower Level Neonate-Per Diem: 1961] [Higher Level Neonate-Per Diem: 2707] [Severe Level Neonate-per diem: 2707] [IP High Cost Drugs ($): 0 Charge Threshold 5000 (%BC): 30] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5000 (%BC): 53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1264]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://mydss.mo.gov/mhd/fee-schedules-rate-lists]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine liposome","code_information":[{"code":"J0666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1.45,"maximum":2.62,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1.48,"additional_payer_notes":"APC"},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.45,"additional_payer_notes":"APC"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2.04,"additional_payer_notes":"APC"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.53,"additional_payer_notes":"APC"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.45,"additional_payer_notes":"APC"}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":0.28,"maximum":0.51,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":0.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":0.29,"additional_payer_notes":"APC"},{"payer_name":"Centene Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.29,"additional_payer_notes":"APC"},{"payer_name":"Centurion","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":0.4,"additional_payer_notes":"APC"},{"payer_name":"Essence","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.3,"additional_payer_notes":"APC"},{"payer_name":"Health Systems","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":0.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.28,"additional_payer_notes":"APC"}]}]},{"description":"Rem mlt day uroflow setup","code_information":[{"code":"0811T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.62,"maximum":240.03,"payers_information":[{"payer_name":"6 Degress Health","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":240.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - 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